Methods and compositions for generating chondrocyte lineage cells and/or cartilage like tissue

ABSTRACT

A method for generating chondrocytes and/or cartilage, optionally articular like non-hypertrophic chondrocyte cells and/or cartilage like tissue and/or hypertrophic chondrocyte like cells and/or cartilage like tissue, the method comprising:
     a. culturing a primitive streak-like mesoderm population, optionally a CD56+, PDGFRalpha+ KDR- primitive streak-like mesoderm population, with a paraxial mesoderm specifying cocktail comprising:
   i. a FGF agonist;   ii. a BMP inhibitor; optionally Noggin, LDN-193189, Dorsomorphin; and   iii. optionally one or more of a TGFbeta inhibitor, optionally SB431524; and a Wnt inhibitor, optionally DKK1, IWP2, or XAV939;   
to specify a paraxial mesoderm population expressing cell surface CD73, CD105 and/or PDGFR-beta;   b. generating a chondrocyte precursor population comprising:
   i. culturing the paraxial mesoderm population expressing CD73, CD105 and/or PDGFR-beta at a high cell density optionally in serum free or serum containing media;   ii. culturing the high cell density CD73+, CD105+ and/or PDGFRbeta+ paraxial mesoderm population with a TGFbeta3 agonist in serum free media to produce a high cell density Sox9+, collagen 2+ chondrocyte precursor population; and   
   c. either
   i. culturing the high cell density Sox9+, collagen 2+ chondrocyte precursor population with the TGFbeta3 agonist for an extended period of time to produce an articular like non-hypertrophic chondrocyte cells and/or cartilage like tissue; or   ii. culturing the high cell density Sox9+ collagen2+ chondrocyte precursor population with a BMP4 agonist for an extended period of time to produce a hypertrophic chondrocyte like cells and/or cartilage like tissue.

This application is a Continuation Application of U.S. Application No.17/980,084, filed Nov. 3, 2022; which is a Continuation Application ofU.S. Application No. 17/709,915, filed Mar. 31, 2022, now abandoned;which is a Continuation Application of U.S. Application No. 17/480,303,filed Sep. 21, 2021, now abandoned; which is a Continuation Applicationof U.S. Application No. 17/200,119, filed Mar. 12, 2021, now abandoned ;which is a Continuation of U.S. Application No. 16/985,323, filed Aug.5, 2020; now abandoned; which is a Continuation Application of U.S.Application No. 15/977,536, filed May 11, 2018, now patented as U.S.Patent No. 10736923; which is a Continuation of U.S. Application No.14/782,070, filed Oct. 2, 2015, now patented as U.S. Patent No. 9993504;which claims priority to PCT International Application No.PCT/CA2014/000312, filed Apr. 2, 2014; which claims the benefit ofProvisional Patent Application No. 61/809,050, filed Apr. 5, 2013 whichis incorporated herein by reference in its entirety.

FIELD

The disclosure relates to methods for producing chondrocytes andcartilage and particularly articular chondrocytes and articularcartilage like tissue as well as hypertrophic chondrocytes and growthplate cartilage resembling tissue from human pluripotent stem cells.

BACKGROUND

The ability to efficiently and reproducibly generate differentiated celltypes from pluripotent stem cells in vitro has opened the door for thedevelopment of cell-based therapies for the treatment of a broad rangeof degenerative and debilitating diseases. Osteoarthritis (OA) is acandidate for such therapy as it affects at least one in ten adults(Lawrence, Felson et al. 2008), leaving patients with a poor quality oflife due to pain associated with joint movement. Pathogenic hallmarks ofOA include the degradation of the extracellular matrix (ECM) ofarticular cartilage that lines the joints together with thickening ofthe underlying subchondral bone and the formation of osteophytes (bonespurs). Articular cartilage is generated by a distinct subpopulation ofchondrocytes known as articular chondrocytes (ACs) that are specifiedearly in development and persist throughout adult life. While ACsfunction to maintain integrity of the articular cartilage under normalcircumstances, they display little capacity to repair cartilage damagedby injury or disease. Consequently, with disease progression, damage tothe cartilage is so extensive that surgical intervention such as jointreplacement is often required to improve the quality of life for thepatient. ACs differ from growth plate chondrocytes (GPCs), whose primaryfunction is to form bone through the process of endochondralossification (Colnot, 2005). Interestingly, with the onset of OA, ACsappear to acquire some characteristics of GPCs, including hypertrophy,which may contribute to the pathogenesis of this disease.

Chondrocyte and cartilage replacement represent a potential new therapyfor OA that could, at some point dramatically reduce the need formechanical devices. This type of therapy, however, is dependent onaccess to appropriate tissue and sufficient numbers of highly enrichedACs. It is well established that adult mesenchymal stem cells (MSCs) areable to differentiate to chondrocytes in vitro, however, it is unclearif they are able to give rise to ACs as the cartilage-like tissuegenerated from them prematurely undergoes hypertrophy (Pelttari, Winteret al. 2006, Steinert, Ghivizzani et al. 2007, Pelttari, Steck et al.2008) Alternatively, ACs have been harvested directly from patients andused for tissue generation ex vivo, despite their limited capacity toproliferate. Tissue generated by passaged chondrocytes exhibitsfibrocartilage characteristics, which can improve the quality of lifefor the patient in the short term but ultimately undergoes degradationas it lacks sufficient weight bearing capacity (Tins, McCall et al.2005, LaPrade, Bursch et al. 2008). Pluripotent stem cells (PSCs) suchas embryonic and induced pluripotent stem cells (ESCs, iPSCs) mayrepresent a novel and potentially unlimited source of chondrocytes andtissues for therapeutic applications as these cells are able to generatea broad spectrum of cell types under appropriate conditions in vitro.

Chondrocytes develop from paraxial mesoderm that is induced in the earlyembryo in an ordered temporal pattern following the generation oflateral plate mesoderm (LPM) fated to give rise to hematopoietic andcardiovascular lineages (Lawson, Meneses et al. 1991, Kinder, Tsang etal. 1999). Following induction, strips of paraxial mesoderm aresegmented into somites (Tam and Tan 1992, Kulesa and Fraser 2002).Somite development is regulated, in part, by the transcription factorsparaxis (TCF15) and TBX18, whose expression coincides with induction ofparaxial mesoderm (Burgess, Rawls et al. 1996, Bussen, Petry et al.2004, Singh, Petry et al. 2005). Individual somites are then patternedinto the ventral sclerotome, which forms the axial skeleton, includingcartilage and the vertebral column, and the dorsal dermomyotome whichdevelops into skeletal muscles and the dermis of the back (Hirsinger,Jouve et al. 2000). Specification of the sclerotome is marked by theexpression of two transcription factors, Meox1 (Mankoo, Skuntz et al.2003) and Nkx3.2 (Bapx1). A population of collagen 2 (CoI2a1) positivemesenchymal cells with chondrogenic potential develops fromsclerotome-derived cells at E12.5 of mouse development (Akiyama,Chaboissier et al. 2002, Dao, Jonason et al. 2012).

While methods for differentiating progenitor cells to the chondrogeniclineage are established, the ability to specify ACs, and ultimatelystable cartilage tissue containing non-hypertrophic chondrocytes,remains poorly understood. ACs are derived from interzone cells, afibrotic population of cells that forms at future sites of synovialjoints, marked by the upregulation of Wnt9a/14 and growth anddifferentiation factor 5 (GDF5/BMP14), a member of the TGFβ superfamily(Archer, Dowthwaite et al. 2003, Pacifici, Koyama et al. 2006). Lineagetracing studies have shown that GDF5-expressing interzone cells giverise to several joint tissues including ACs, but do not contribute tothe GPC population (Koyama, Shibukawa et al. 2008). GPCs, by contrast,develop from the condensing chondrogenic mesenchyme and express BMP 2, 4and 7, as well as hypertrophy related genes including collagen 10.Distinct regions of ACs and GPCs are observed as early as postnatal day7-8 when the secondary ossification center begins to form (Murakami,Balmes et al. 2004, Blumer, Longato et al. 2007). These observationssuggest that ACs and GPCs are generated from separate progenitorpopulations during development and as such, may represent distinctlineages.

A number of studies have demonstrated that it is possible to derivechondrocytes from mouse (m) and human ESCs and iPSCs in vitro. Most,however, used serum-based media to support the early stages ofdifferentiation resulting in the generation of mixed lineage end stagecultures (Kramer, Hegert et al. 2000, zur Nieden, Kempka et al. 2005,Hwang, Kim et al. 2006, Hwang, Varghese et al. 2008, Jukes, Both et al.2008, Yamashita, Krawetz et al. 2008). Recent studies have reported theuse of defined culture media with specific pathway agonists andantagonists to direct differentiation (Nakayama, Duryea et al. 2003,Darabi, Gehlbach et al. 2008, Tanaka, Jokubaitis et al. 2009). In mESCs,Tanaka et al (2009) showed that the combination of Wnt signaling withBMP inhibition resulted in the generation of paraxial mesoderm withchondrogenic potential, identified by the expression of PDGFRalpha and alack of expression of Flk-1. This mesoderm also displayed some cardiacpotential but showed no capacity to generate hematopoietic cellsindicating that dependency on BMP signaling distinguishes differenttypes of mesoderm.

Oldershaw et al. (Oldershaw, Baxter et al. 2010) used a serum freeprotocol. No tissues were obtained in vitro or in vivo with the methodof Oldershaw.

Umeda et al (Umeda, Zhao et al. 2012) used a method using PDGFstimulation that produced nodules comprising Runx2 expressing cells.

Osteoarthritis is a degenerative disease that mainly affects thejoint-lining articular cartilage of the joint. Articular cartilage hasvery limited capacity to regenerate itself upon injury, thus cell andtissue replacement strategies are the only means of replacing thistissue effectively. Methods of producing human cartilage frompluripotent stem cells are currently lacking, despite great need forsuch tissues for drug discovery and cartilage replacement strategies inpatients with joint diseases such as osteoarthritis.

SUMMARY

An aspect of the application provides a method for generatingchondrocyte lineage cells and/or cartilage like tissue, optionallyarticular like non-hypertrophic chondrocyte cells and/or cartilage liketissue and/or hypertrophic chondrocyte like cells and/or cartilage liketissue, the method comprising:

-   (a) culturing a primitive streak-like mesoderm cell population (e.g.    stage 2), optionally a CD56+, PDGFRalpha+ primitive streak-like    mesoderm cell population, with a paraxial mesoderm specifying    cocktail comprising:    -   (i) a FGF agonist;    -   (ii) a BMP inhibitor, optionally Noggin, LDN-193189, and/or        Dorsomorphin; and    -   (iii) optionally one or more of a TGFbeta inhibitor, optionally        SB431542; and a Wnt inhibitor, optionally IWP2        (N-(6-Methyl-2-benzothiazolyl)-2-[(3,4,6,7-tetrahydro-4-oxo-3-phenylthieno[3,2-d]pyrimidin-2-yl)thio]-acetamide;        Sigma); Dickkopf-related protein 1 (DKK1; R & D Systems), and/or        XAV939        (3,5,7,8-Tetrahydro-2-[4-(trifluoromethyl)phenyl]-4H-thiopyrano[4,3-d]pyrimidin-4-one;        Sigma);

    to specify a paraxial mesoderm cell population expressing cell    surface CD73, CD105 and/or PDGFR-beta;-   (b) generating a chondrocyte precursor population from the paraxial    mesoderm cell population expressing cell surface CD73, CD105 and/or    PDGFR-beta, the generating the chondrocyte precursor population    comprising:    -   (i) culturing the paraxial mesoderm cell population expressing        cell surface CD73, CD105 and/or PDGFR-beta at a high cell        density in serum free or serum containing media;    -   (ii) culturing the high cell density CD73+, CD105+ and/or        PDGFRbeta+ paraxial mesoderm cell population with a TGFbeta        agonist, optionally TGFB1, TGFB2 and/or TGFB3 in serum free        media to produce a high cell density Sox9+, collagen 2+        chondrocyte precursor population (e.g. Stage 3); and-   (c) either:    -   (i) culturing the high cell density Sox9+, collagen 2+        chondrocyte precursor population with a TGFbeta agonist        (optionally TGFBeta1, TGFbeta2 and/or TGFBeta3) for an extended        period of time to produce articular like non-hypertrophic        chondrocyte like cells and/or cartilage like tissue; or    -   (ii) culturing the high cell density Sox9+ collagen2+        chondrocyte precursor population with a BMP4 agonist for an        extended period of time to produce hypertrophic chondrocyte like        cells and/or cartilage like tissue (e.g. stage 4).

Another aspect includes a method for generating chondrocyte like cellsand/or cartilage like tissue, optionally articular like non-hypertrophicchondrocyte like cells and/or cartilage like tissue and/or hypertrophicchondrocyte like cells and/or cartilage like tissue, the methodcomprising:

-   (a) culturing a starting population of pluripotent stem cells with a    primitive streak inducing cocktail to induce a primitive streak-like    mesoderm cell population expressing CD56 and/or PDGFR-alpha (e.g.    stage 1);-   (b) culturing the primitive streak-like mesoderm cell population    expressing CD56 and PDGFR-alpha with a paraxial mesoderm specifying    cocktail comprising:    -   (i) a FGF agonist;    -   (ii) a BMP inhibitor, optionally Noggin, LDN-193189, and/or        Dorsomorphin; and    -   (iii) one or more of a TGFbeta inhibitor, optionally SB431524;        and a Wnt inhibitor, optionally DKK1, IWP2 and/or XAV939;

    to specify a paraxial mesoderm cell population expressing cell    surface CD73, CD105 and PDGFR-beta;-   (c) generating a chondrocyte precursor population from the paraxial    mesoderm cell population expressing cell surface CD73, CD105 and/or    PDGFR-beta, the generating the chondrocyte precursor population    comprising:    -   (i) culturing the paraxial mesoderm cell population expressing        CD73, CD105 and/or PDGFR-beta at a high cell density in serum        free or serum containing media;    -   (ii) culturing the high cell density CD73+, CD105+ and        PDGFRbeta+ paraxial mesoderm cell population with a TGFbeta        agonist in serum free media to produce a high cell density        Sox9+, collagen 2+ chondrocyte precursor population; and-   (d) either    -   (i) culturing the high cell density Sox9+, collagen 2+        chondrocyte precursor population with a TGFbeta agonist for an        extended period of time to produce articular like        non-hypertrophic chondrocyte like cells and/or cartilage like        tissue; or    -   (ii) culturing the high cell density Sox9+ collagen2+        chondrocyte precursor population with a BMP4 agonist for an        extended period of time to produce hypertrophic chondrocyte like        cells and/or cartilage like tissue.

In an embodiment, the method is for generating articular likenon-hypertrophic chondrocyte like cells and/or cartilage like tissue. Inanother embodiment, the method is for generating hypertrophicchondrocyte like cells and/or cartilage like tissue.

In an embodiment, the extended period of time the high cell densitySox9+ collagen2+ chondrocyte precursor population is cultured with theTGF beta agonist is at least 3 weeks, at least 4 weeks, at least 5weeks, at least 6 weeks, at least 7 weeks, at least 8 weeks, at least 9weeks, at least 10 weeks, at least 11 weeks, at least 12 weeks or moreto generate a non-hypertrophic chondrocyte like and/or cartilage liketissue that expresses for example lubricin and CILP2.

In an embodiment, the extended period of time the high cell densitySox9+ collagen2+ chondrocyte precursor population is cultured with theBMP4 agonist is at least 3 weeks, at least 4 weeks, at least 5 weeks, atleast 6 weeks, at least 7 weeks, at least 8 weeks, at least 9 weeks, atleast 10 weeks, at least 11 weeks, at least 12 weeks or more to generatea cartilage like tissue that expresses collagen 2 or hypertrophicchondrocyte cells that express collagen 10.

A method of generating chondrocyte like cells comprising:

-   (a) culturing chondrocyte precursor cells at a high cell density in    serum free or serum containing media;-   (b) culturing the high cell density chondrocyte precursor cells with    a TGFbeta agonist in serum free media; and-   (c) either    -   (i) culturing the chondrocyte precursor cells with a TGFbeta        agonist for an extended period of time to produce articular        cartilage like chondrocyte cells; or    -   (ii) culturing the chondrocyte precursor cells with a BMP4        agonist for an extended period of time to produce hypertrophic        chondrocyte lineage cells and/or cartilage like tissue.

In an embodiment, the chondrocyte precursor cells are primary fetalchondrocytes or passaged fetal chondrocytes.

In an embodiment, the generated cells and/or tissues are administered toa subject.

Also provided in another embodiment is an isolated population ofarticular like non-hypertrophic chondrocyte like cells and/or cartilagelike tissue and/or hypertrophic chondrocyte like cells and/or cartilagelike tissue generated according to a method described herein.

A further aspect includes composition comprising the population ofarticular like non-hypertrophic chondrocyte like cells and/or cartilagelike tissue and/or hypertrophic chondrocyte like cells and/or cartilagelike tissue, and a carrier optionally PEG, hydrogel, bone scaffolding,bone substitute scaffolding and/or matrigel. In an embodiment, thecarrier is pharmaceutical grade.

In an embodiment, the isolated population is comprised in a compositioncomprising a diluent or carrier, optionally a pharmaceutical diluent. Inan embodiment, the diluent is culture media, optionally comprising acryopreservation agent such as glycerol and/or DMSO, serum and albumin,such as human serum albumin.

A further aspect includes a cartilage and/or bone tissue productcomprising the cells or composition described herein, and a scaffold.

Another aspect includes method for ameliorating symptoms and/or treatinga subject in need thereof comprising administering cells and/or tissuegenerated using a method described herein and/or transplanting acartilage and/or bone tissue product described herein.

Also provided in another aspect is use of cells and/or tissue generatedusing a method described herein and/or a cartilage and/or bone tissueproduct comprising said cells and/or tissue for ameliorating symptomsand/or treating a subject in need thereof.

A further aspect includes a method of generating a paraxial mesodermcell population comprising:

-   (a) culturing a starting population of pluripotent stem cells with a    primitive streak inducing cocktail to induce a primitive streak-like    mesoderm cell population expressing CD56 and PDGFR-alpha (e.g. stage    0);-   (b) culturing a primitive streak-like mesoderm cell population    expressing CD56 and PDGFR-alpha with a paraxial mesoderm specifying    cocktail comprising:    -   (i) a FGF agonist; and    -   (ii) a BMP inhibitor, optionally Noggin, LDN-193189,        Dorsomorphin; and    -   (iii) one or more of a TGFbeta inhibitor, optionally SB431524;        and a Wnt inhibitor, optionally DKK1, IWP2, and/or XAV939;

to specify a paraxial mesoderm cell population expressing cell surfaceCD73, CD105 and PDGFR-beta.

Methods of isolating cells and screening assays are also provided.

Other features and advantages of the present disclosure will becomeapparent from the following detailed description. It should beunderstood, however, that the detailed description and the specificexamples while indicating preferred embodiments of the disclosure aregiven by way of illustration only, since various changes andmodifications within the spirit and scope of the disclosure will becomeapparent to those skilled in the art from this detailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

An embodiment of the present disclosure will now be described inrelation to the drawings in which:

FIG. 1 . Serum-free differentiation of paraxial mesoderm, chondrocyteprogenitors, and cartilage tissues from human pluripotent stem cells(hPSCs). (A) hPSCs are differentiated in 4 stages including theinduction of a primitive streak-like mesoderm population (stage 1) usingActivin A, BMP4 and basic (b) FGF from days 1 to 4 of differentiation asembryoid bodies. On day 4 (T4), mesoderm populations are monitored bythe expression of CD56 and PDGFRa on the cell surface by flow cytometry(B). Day 4 mesoderm cells are specified to a paraxial mesoderm fate inmonolayer culture by treatment of Dorsomorphin, a BMP inhibitor, aTGFbeta inhibitor SB431542, and bFGF, from days 4 to 6 and bFGF fromdays 4 to 15 (stage 2). Day 15 paraxial mesoderm cells can generatechondrocyte progenitors by plating in a high density ‘spot’ termedmicromass, or by plating onto collagen coated membrane filters (notshown) in the presence of TGFB3 for approximately 10 days (stage 3).Chondrocyte progenitors can be specified to articular chondrocytes orgrowth plate-like chondrocytes in a cartilage tissue format during stage4 of differentiation by extended stimulation with TGFB3 (articular) orBMP3 (growth plate-like) for example for 12 weeks. Tissues have beenkept in culture for at least 7 months. Efficient induction of aprimitive streak-like population from hESCs (C) and hIPSCs (D,E) wasconfirmed by the expression of CD56 and PDGFRα by flow cytometry on day3 of differentiation. hESCs were induced to generate a primitive streakpopulation with the following cytokines: Activin A (2 ng/ml), BMP4 (3ng/ml) and basic (b)FGF (5 ng/ml). hiPSCs were induced to generate aprimitive streak-like mesoderm population (Stage 1) using Activin A (3ng/ml), BMP4 (1 ng/ml), bFGF (5 ng/ml) in the presence (C) or absence(D) of the Wnt pathway agonist CHIR99061 (1 µM) from days 1 to 3 ofdifferentiation as embryoid bodies.

FIG. 2 . Characterization of paraxial mesoderm derived from hPSCs. Flowcytometric analysis of day 5 mesoderm treated with no additional factors(0 DM, no FGF), FGF, 4 µM DM, or 4 µM DM+FGF. Day 5 profiles depict KDRand PDGFRa expression, a double-positive population (gated) indicatesmesoderm that has cardiac potential (20). Treatment with FGF results inless PDGFRa expression on day 5. (B) Expression of cell surface markersCD73, CD105, and PDGFR-beta on mesoderm populations on day 15 ofdifferentiation. (C) Wnt inhibition can also improve the efficiency ofCD73 and CD105 expression. Experimental cell treatments during day 4 today 6 include the combination of Dorsomorphin, bFGF, TGFbeta inhibitor(SB431542) in the presence or absence of the wnt pathway inhibitor IWP2.Flow cytometric analyses of CD73 and CD105, on day 15 mesodermpopulations derived as indicated. (D) Gene expression analyses of day 15mesoderm populations derived in indicated factors. Nkx2.5 is a cardiactranscription factor, Meox1 and Nkx3.2 are paraxial mesoderm and somitetranscription factors. (E) Micrographs depicting 1 day old micromassesand 1 week old micromasses derived from day 15 mesoderm populations asindicated. (F) Flow cytometric analysis of cardiac troponin T (cTnT)expression in 1 week old micromasses derived from day 15 mesoderms asindicated. (G) 4 week old micromasses derived from DM+FGF-treatedparaxial mesoderm generates cartilage tissues, but mesoderm specifiedwith FGF alone do not generate cartilage-like tissues (see non-adherentaggregates).

FIG. 3 . CD73+CD105+PBeta+ cells contain chondrocyte potential and thepotential to generate cartilage-like tissues in-vitro. (A) Flowcytometric analysis of DM+FGF-treated paraxial mesoderm on day 12 andday 15. Double-positive (CD73+CD105+ and CD73+PBeta+) populations wereisolated from the double-negative populations by cell sorting and platedin micromass culture. (B) Micromass cultures after 10 days of culture.(C) Micromass cultures after 2 weeks of culture. (D) Photographs ofcartilage tissues derived from sorted populations after 5 weeks ofculture.

FIG. 4 . TGFB3 and BMP4 specify chondrocytes and cartilage-like tissueswith articular cartilage and growth plate cartilage phenotypes. (A)Micrographs of 5 week old micromasses derived with TGFB3 or BMP4, 20xmagnification. (B) Tissue histology (stained with toluidine blue) of 13week cartilage tissues derived with TGFB3 or BMP4. Toluidine blue stainscartilage tissues metachromatically, and these tissue sections arepink/purple in color indicating that cartilage tissue is present. (C)Flow cytometric analysis of forward and side cell scatter parameters of3 week and 5 week old micromasses. Side scatter indicates cellgranularity and forward cell scatter indicates cell size. (D) Comparisonof hPSC-derived micromass tissues to fetal primary chondrocyte derivedmicromass tissues and the developing human fetal femur cartilage.Articular cartilage regions appear to have smaller cells in sizecompared to growth plate like regions, which contain cells which appearenlarged (hypertrophic). Cartilage tissues in micromass as well as inthe fetal femur stain uniformly with the toluidine blue stain (imagesare pink/purple in color and indicate the presence of cartilageproteins). The BMP4-treated micromass tissues contain a large number ofenlarged cells which is similar to the bottom panel of the fetalcartilage which represents a growth plate cartilage. TGFB3 treatedmicromass cultures contain fewer, if any, enlarged chondrocytes, andappear similar to the upper panel of the fetal cartilage which is thesite of articular cartilage. (E) Micrograph using GDF5 instead of BMP4to generate hypertrophic chondrocytes. (F) Histological analyses ofcartilage tissues derived from hiPSCs stained with Toluidine blue after12 weeks. (G,H) Immunohistochemical staining of hESC-derived cartilagetissues for type II Collagen (G, 8 week tissues), and lubricin (H, 12week tissues).

FIG. 5 . Gene expression analyses of chondrocyte specification in thepresence of TGFB3 or BMP4 during stages 3 and 4 of differentiationrespectively. General chondrocyte genes Sox9 (A) and collagen 2 (B),hypertrophic genes collagen 10 (C), Runx2 (D), osterix (E) and alkalinephosphatase (F), articular cartilage associated genes lubricin (G) andcartilage intermediate layer protein 2 (CILP2) (H), interzone-related(joint progenitor) genes GDF5 (I), ERG (J) and Wnt9a (K). Expression iscopy number relative to TBP (n = 3 to 8 biological replicates) and iscompared to primary fetal chondrocytes (aged 16 to 19 weeks, n = 4),primary healthy adult articular chondrocytes (n = 2), and growthplate-like chondrocytes isolated from the iliac crest of an adult (n =1). T15 Mesoderm indicates day 15 hESC-derived paraxial mesoderm(DM+FGF-treated). Error bars indicate s.e.m.

FIG. 6 . CD73 is expressed by articular chondrocytes. Flow cytometricanalyses of primary chondrocytes (A) Healthy adult articularchondrocytes and iliac crest GPC-like chondrocytes, (B) Primary fetalchondrocytes, primary (C) or passaged (passage (P)2, D) fetalchondrocytes after 9 to 10 weeks of micromass culture in the presence ofTGFB3 or BMP4, and (E) hPSC-derived chondrocytes after 11 weeks derivedin the presence of TGFB3 or BMP4. (F) Time course of CD73 and PDGFR-betacells surface expression on T12 and T15 paraxial mesoderm populations,and micromass cultures treated with TGFB3 after 3 days, 10 days, and 2weeks. (G) Time course of CD73 expression on TGFB3-treated micromassesafter 3 days, 7 days, 10 days, and 2 to 5 weeks.

FIG. 7 . hPSC-derived chondrocytes maintain respective articular orhypertrophic chondrocyte phenotypes in vivo. Micromass tissues (aged8-12 weeks) treated with TGFβ3 or BMP4 were dissociated by collagenasetreatment and chondrocytes were injected subcutaneously intoimmunodeficient mice for 12 weeks. Grafts were harvested and analyzedhistologically after 12 weeks. Sections were stained with Toluidine blue(A, C) to indicate the presence of proteoglycans and von Kossa (B) toidentify areas of mineralization. Type II (D) and type X collagen (E)was detected immunohistochemically. After 12 weeks in vivo,TGFβ3-treated chondrocyte-derived grafts stained positive for type IIcollagen (D) and stained metachromatically with toluidine blue (A, C),and no areas of von Kossa (B) or type X collagen positivity (E) werefound. Areas of mineralization (B), von Kossa positive, black) wereidentified in grafts derived from BMP4-treated chondrocytes after 12weeks, but these areas contained little proteoglycan (A, C) and stainedpositively for type II (D) and type X collagen (E), indicating thedevelopment of calcified cartilage.

FIG. 8 . TGFβ1, TGFβ2, and TGFβ3 generated articular chondrocytes fromhPSC-derived paraxial mesoderm. COL2A1, lubricin, and CILP2 geneexpression after 12 weeks of micromass culture in the presence of TGFβagonists as indicated (10 ng/ml). Values represent copy number mRNArelative to TBP. Error bars indicate s.e.m.

FIG. 9 . hPSC-derived articular-like cartilage respond appropriately tothe pro-inflammatory molecule IL1β. (A) The experimental plan isdepicted. Articular cartilage tissues were derived from hPSCs for 10weeks in the presence of TGFβ3. Cartilage tissues (micromasses) weretreated for two weeks (from week 10-12) with TGFβ3 or IL1β (10 ng/ml),as indicated. Cartilage tissues were analyzed histologically ordissociated for gene expression analyses. hPSC-derived articularchondrocytes significantly upregulated the expression of MMP13 (B), MMP2(C), ADAMTS4 (D) and ADAMTS5 (E) in response to exogenous IL1β. (F, G)Genes encoding extracellular matrix components, COL2A1 and ACAN, aresignificantly downregulated in response to IL1β. (H, I) Expression ofsuperficial zone chondrocyte genes PRG4 (lubricin) and CILP2 weredownregulated in presence of IL1β. (J) VEGF was upregulated in thepresence of IL1β. Values represent copy number mRNA relative to TBP(n=7). Error bars indicate s.e.m. (K) Histological analysis of 12-weektissues after treatments as indicated. Metachromatic toluidine bluestaining indicates proteoglycans.

DETAILED DESCRIPTION OF THE DISCLOSURE 1. Definitions

The term “primitive streak-like mesoderm cell population” as used hereinmeans a population of mesoderm cells expressing Brachyury and the cellsurface markers CD56 and PDGFRalpha. For example, the primitivestreak-like mesoderm cell population can comprise at least 50%, at least60%, at least 70%, at least 80% or about 90% cells expressing CD56 andPDGFRalpha Cartilage differentiation has been obtained with thedisclosed methods using for example 50% CD56/PDGFRalpha+ cells.

The term “paraxial mesoderm cell population expressing cell surfaceCD73, CD105 and/or PDGFR-beta” as used herein means mesoderm cellsexpressing CD73, CD105 and/or PDGFR-beta and the paraxial mesodermtranscription factor Meox1. For example, the paraxial mesoderm cellpopulation comprises at least 70% cells expressing Meox1, CD73, CD105and/or PDGFR-beta As shown in FIG. 2D. Meox1 expression is increased inFGF and Dorsomorphin treated cells compared to non FGF and Dorsomorphintreated cells.

As used herein, the term “express” refers to the transcription of apolynucleotide or translation of a polypeptide in a cell, such thatlevels of the molecule are measurably higher in a cell that expressesthe molecule than they are in a cell that does not express the molecule.Methods to measure the expression of a molecule are well known to thoseof ordinary skill in the art, and include without limitation, Northernblotting, RT-PCR, in situ hybridization, Western blotting, andimmunostaining such as FACS.

The term “expressing” also represented as “+” as used herein means, withrespect to a cell protein level, detectable protein expression comparedto a cell that is not expressing the protein, for example as measured byFACS analysis. Using FACS analysis, a cell is considered positivelyexpressing the protein on the cell surface if the mean fluorescence ofthe signal is brighter than a cell that was not stained with theantibody (unstained control) or cells that were stained with theantibody but do not express the protein on the cell surface. Withrespect to a cell population, “expressing” as used herein means at least50% of the cells in the cell population express the marker. In anembodiment, the cells expressing for example cells expressing CD73 orthe other markers are sorted such that for example 70%, 80, 90% or moreof the cells are positive and express the marker.

The term “lacking expression” also represented as “-” as used hereinmeans with respect to a cell protein level, undetectable proteinexpression compared to a cell that is expressing the protein, forexample as measured by FACS analysis. With respect to a cell population,“lacking expression” as used herein means less than 25%, less than 20%,less than 15%, less than 10%, less than 5% or less than 1 % of the cellsin the cell population express the marker.

The term “culturing” as used herein incubating and/or passaging cells inan adherent, suspension or 3D culture. As used herein, the term“adherent culture” refers to a cell culture system whereby cells arecultured on a solid surface, which may in turn be coated with aninsoluble substrate that may in turn be coated with another surface coatof a substrate, such as those listed below, or any other chemical orbiological material that allows the cells to proliferate or bestabilized in culture. The cells may or may not tightly adhere to thesolid surface or to the substrate. The substrate for the adherentculture may comprise any one or combination of tissue culture treatedplastic, polyornithine, laminin, poly-lysine, purified collagen,gelatin, fibronectin, tenascin, vitronectin, entactin, heparin sulfateproteoglycans, poly glycolytic acid (PGA), poly lactic acid (PLA), andpoly lactic-glycolic acid (PLGA). In one embodiment, the cells areplated on MATRIGEL®-coated plates. In another embodiment, the cells areplated on fibronectin-coated plates. Cells can be cultured in filtercultures and micromass cultures. In an embodiment, cells are plated ontomembrane filters, optionally those that are placed into tissue culturesdishes as part of a transwell system (Millipore, alvatex are twobrands). The substrate could also be a bone scaffold substitute such asCPP (calcium polyphosphate) or other pharmaceutically availablescaffolds available. Micromass culture is comprised of a high densitysuspension of cells is permitted to adhere to a small area of thesubstrate (e.g. 200,000-500,000 cells adhere to a 0.2-1 cm diametercircular area of the substrate). Any shape or size of substrate can beused, prepared for example by 3D printing. The term “suspension” as usedin the context of cell culturing is used as it is in the art. Namely,cell culture suspensions are cell culture environments where the cellsdo not adhere to a surface. One of skill in the art will be familiarwith suspension culture techniques, including, but not limited to, theuse of equipment such as flow hoods, incubators and/or equipment used tokeep the cells in constant motion, e.g., rotator platforms, shakers,etc, if necessary.

The term “contacting” or “culturing ... with” s intended to includeincubating the component(s) and the cell/tissue together in vitro (e.g.,adding the compound to cells in culture) and the step of “contacting” or“culturing... with” can be conducted in any suitable manner. For examplethe cells may be treated in adherent culture, or in suspension culture,or in 3D culture; the components can be added temporally substantiallysimultaneously (e.g. together in a cocktail) or sequentially (e.g.within 1 hour, 1 day or more from an addition of a first component). Thecells can also be contacted with another agent such as a growth factoror other differentiation agent or environments to stabilize the cells,or to differentiate the cells further and include culturing the cellsunder conditions known in the art. Stage 1 for example is typicallypracticed in suspension culture. Stag 2 is in an embodiment carriedoutin suspension. Stage 3and/or4 can for example be carried out insuspension culture for example if the cells are aggregated in a pelletformat instead of a micromass or filter format. Pellet cultures are acluster of cells at high density that can float in suspension in a tube.In an embodiment, part of a stage is carried out in suspension or mixedsuspension and adherent, optionally 3D culture. For example, sometissues become non-adherent over time and are thus in suspension forsome of the culture period of stage 4.

The term “high cell density” as used herein means about 200,000 cells -about1,000,000 cells per about 0.2 cm - about 2 cm diameter surface area(2D), or with respect to micromass is at least about 100,000 cells perabout 20 microliters of media, or for example upt to about 2,000,000cells per about 20 microliters of media to allow for cells to adhere tothe small surface area permitted for a micromass ‘spot’. For membranefilters, the area is dependent on the commerically available membranethat is purchased, for example approximately 400,000 cells- about2,000,000 cells can be plated in about 200 microliters - about 500microliters of media in for example a about 1 cm - about 2 cm cylindershaped membrane filter-containing insert to allow cells to adhere. Inboth mircomass and membrane filter culture, cells adhere in about a 1-5cell layer and tissue is permitted to grow ‘thicker ‘after adherence. Asimilar cell density could be used to seed onto a bone substitutescaffold such as the CPP.

As used herein, “serum free” refers to the absence of serum in thesolutions e.g. medias used to culture the given cell population. Forexample, serum free medium or environment can contain less than 4, 3, 2,or 1% serum. In a preferred embodiment, the serum free composition doesnot contain serum, or only contains trace amounts of serum from theisolation of components that are added to the defined media (e.g.contains 0% added serum).

The term “BMP inhibitor” as used herein means any inhibitor of BMPsignaling and includes for example a type 1 BMP receptor inhibitor, BMPligands and/or soluble BMP receptors, optionally selected fromdorsomorphin (DM), noggin, Chordin, LDN-193189, soluble BMPR1a, and/orsoluble BMPR1b.

The term “FGF agonist” as used herein means a molecule such as acytokine, including for example FGF, or a small molecule, that activatesa FGF signalling pathway, e.g binds and activates a FGF receptor.

The term “FGF” as used herein refers to any fibroblast growth factor,and optionally bFGF, FGF2, FGF4, FGF9 and/or optionally FGF 19, 21, 3,5, 6, 8a, 16-18, 20 and/or 23, for example human FGF1 (Gene ID: 2246),FGF2 (also known as bFGF; Gene ID: 2247), FGF3 (Gene ID: 2248), FGF4(Gene ID: 2249), FGF5 (Gene ID: 2250), FGF6 (Gene ID: 2251), FGF7 (GeneID: 2252), FGF8 (Gene ID: 2253), FGF9 (Gene ID: 2254) and FGF10 (GeneID: 2255) optionally including active conjugates and fragments thereof,including naturally occuring active conjugates and fragments. In certainembodiments, FGF is bFGF, FGF2, FGF4, and/or FGF9. As used herein,“active conjugates and fragments of FGF” include conjugates andfragments of a fibroblast growth factor that bind and activate a FGFreceptor and optionally activate FGF signalling.

The term “TGFbeta agonist” or TGFb agonist as used herein any moleculethat promotes TGFbeta signaling and includes for example TGFb1, TGFb2and/or TGFb3.

The term “TGFbeta inhibitor” as used herein means any molecule thatinhibits receptors ALK4 and ALK7 and/or TGF-βRl, for example SB431542(Sigma Aldrich) A83-01 (Tocris, 2929), D 4476, GW 788388, LY 364947,RepSox, SB 505124, SB 525334 (Sigma Aldrich), and SD 208.

The term “BMP4 agonist” as used herein means any molecule optionally anyBMP or GDF that activates the receptor for BMP4, including for exampleGDF5, GDF6, GDF7, BMP4, BMP2, BMP6, BMP7 and/or, BMP10.

The term “BMP4” (for example Gene ID: 652) as used herein refers to BoneMorphogenetic Protein 4, for example human BMP4, as well as activeconjugates and fragments thereof, optionally including naturallyoccuring active conjugates and fragments, that can for example activateBMP4 receptor signlaing.

The term “nodal agonist” as used herein means any molecule thatactivates nodal signal transduction such as “nodal” (for example humannodal such as Gene ID: 4338) or “activin” in a hepatocyte lineage cell.

The term “activin” or “ActA” as used herein refers to “Activin A” ( forexample Gene ID: 3624), for example human activin, as well as activeconjugates and fragments thereof, optionally including naturallyoccuring active conjugates and fragments, that can for example activatenodal signal transduction as well as active conjugates and fragmentsthereof, including naturally occuring active conjugates and fragments.

The term “a wnt agonist” as used herein means any molecule thatactivates wnt/beta-catenin receptor signaling in a chondrocyte lineagecell and incldues for example Wnt3a and as well as GSK3 selectiveinhibitors such as CHIR99021 (Stemolecule™ CHIR99021 Stemgent),6-Bromolndirubin-3′-Oxime (BIO) (Cayman Chemical (cat:13123)), orStemolecule™ BIO from Stemgent (cat:04003). CHIR99021 is a selectiveinhibitor of GSK3. The GSK3 selective inhibitors contemplated are forexample selective inhibitors for GSK-3α/β in the Wnt signaling pathway.

The term “Wnt3a” as used herein refers to wingless-type MMTV integrationsite family, member 3A factor (e.g. Gene ID: 89780), for example humanWnt3a, as well as active conjugates and fragments thereof, includingnaturally occuring active conjugates and fragments.

The term “Wnt antagonist” or “wnt inhibitor” as used herein means anymolecule that inhibits wnt/beta cantenin receptor signaling in achondrocyte lineage cell, including for example IWP2(N-(6-Methyl-2-benzothiazolyl)-2-[(3,4,6,7-tetrahydro-4-oxo-3-phenylthieno[3,2-d]pyrimidin-2-yl)thio]-acetamide;Sigma); Dickkopf-related protein 1 (DKK1; R & D Systems), and/or XAV939(3,5,7,8-Tetrahydro-2-[4-(trifluoromethyl)phenyl]-4H-thiopyrano[4,3-d]pyrimidin-4-one;Sigma).

The term “agonist” as used herein means an activator, for example, of apathway or signaling molecule. An agonist of a molecule can retainsubstantially the same, or a subset, of the biological activities of themolecule (e.g. nodal). For example, a nodal agonist means a moleculethat selectively activates nodal signaling.

The term “inhibitor” as used herein means a selective inhibitor, forexample of a pathway or signaling molecule. An inhibitor or antagonistof a molecule (e.g. BMP4 inhibitor) can inhibit one or more of theactivities of the naturally occurring form of the molecule. For example,a BMP4 inhibitor is a molecule that selectively inhibits BMP4 signaling.

The term “selective inhibitor” as used herein means the inhibitorinhibits the selective entity or pathway at least 1.5X, 2X, 3X, 4X or10X more efficiently than a related molecule.

The term “specifying” as used herein means a process of committing acell toward a specific cell fate, prior to which the cell type is notyet determined and any bias the cell has toward a certain fate can bereversed or transformed to another fate. Specification induces a statewhere the cell’s fate cannot be changed under typical conditions.Specification is a first step of differentiation.

The term “stem cell” as used herein, refers to an undifferentiated cellwhich is capable of proliferation, self-renewal and giving rise to moreprogenitor or precursor cells having the ability to generate a largenumber of mother cells that can in turn give rise to differentiated, ordifferentiable, daughter cells. The daughter cells can for example beinduced to proliferate and produce progeny cells that subsequentlydifferentiate into one or more mature cell types, while also retainingone or more cells with parental developmental potential. The term “stemcell” includes embryonic stem cell and pluripotent stem cell.

The term “embryonic stem cell” is used to refer to the pluripotent stemcells of the inner cell mass of the embryonic blastocyst (see, forexample, U.S. Pat. Nos. 5,843,780, 6,200,806). Such cells can also beobtained from the inner cell mass of blastocysts derived from somaticcell nuclear transfer (see, for example, U.S. Pat. Nos. 5,945,577,5,994,619, 6,235,970).

The term “pluripotent stem cell” as used herein refers to a cell withthe capacity, under different conditions, to differentiate to more thanone differentiated cell type, and for example the capacity todifferentiate to cell types characteristic of the three germ celllayers. Pluripotent cells are characterized by their ability todifferentiate to more than one cell type using, for example, a nudemouse teratoma formation assay. Pluripotency is also evidenced by theexpression of embryonic stem (ES) cell markers. Pluripotent stem cellsinclude induced pluripotent stem cells (iPSC) and embryonic stem cells.In an embodiment, the pluripotent stem cell is derived from a somaticcell. In an embodiment, the pluripotent stem cell is derived from ahuman somatic cell.

As used herein, the terms “iPSC” and “induced pluripotent stem cell” areused interchangeably and refers to a pluripotent stem cell artificiallyderived (e.g., induced or by complete reversal) from a non-pluripotentcell, typically an adult somatic cell, for example, by inducingexpression of one or more genes including POU4F1/OCT4 (Gene ID; 5460) incombination with, but not restricted to, SOX2 (Gene ID; 6657), KLF4(Gene ID; 9314), cMYC (Gene ID; 4609), NANOG (Gene ID; 79923), LIN28/LIN28A (Gene ID; 79727)). The expression can be induced for example byforced gene expression or using small molecules, small RNAs,non-integrating gene expression vectors, or proteins.

The term “chondrocyte like cells” as used herein means chondrocyte cellsand cells that are cytochemically similar and express chondrocytemarkers, including for example Sox9 and Collagen 2, and behave aschondrocyte cells. The chondrocyte cells can be articular cartilage likechondrocytes or precursors or chondrocytes that are capable ofhypertrophy (optionally referred to as GPC like cells) or precursorsthereof.

The term “cartilage like tissue” as used herein means cartilage tissueand tissue that is histologically similar and expresses cartilagemarkers, for example collagen 2 and aggrecan, and behaves as cartilage,including articular cartilage tissue and/or growth plate cartilage liketissue.

The term “articular chondrocyte like cells and/or cartilage tissue” asused herein means a population, optionally enriched or mixed, comprisingarticular chondrocyte cells and/or articular chondrocyte like cellsincluding for example, cartilage like tissue comprising articularchondrocyte like cells.

The term “hypertrophic chondrocyte like cells and/or cartilage tissue”or “GPC like cells and/or cartilage tissue” as used herein means apopulation, optionally enriched or mixed, comprising hypertrophicchondrocyte cells and/or hypertrophic chondrocyte like cells (e.g. iliaccrest chondrocytes) including for example, cartilage like tissuecomprising hypertrophic chondrocyte like cells.

The term “articular cartilage like tissue” or “cartilage containing nonhypertrophic chondrocyte-like cells” is histologically similar andexpresses articular cartilage markers such as lubricin and/or CILP2 andbehaves as articular cartilage. For example, articular cartilage ismaintained as stable cartilage in vivo.

The tem “growth plate cartilage like tissue” as used herein meanscartilage tissue that is histologically similar and expresses cartilagemarkers that are found in growth plate cartilage tissue includingcollagen X, RUNX2, SP7 and/or alkaline phosphates and behaves likegrowth plate cartilage For example, growth plate cartilage functions invivo to provide a scaffold onto which new bone will form.

The term “isolated population” with respect to an isolated population ofcells as used herein refers to a population of cells that has beenremoved and separated from a mixed or heterogeneous population of cells.In some embodiments, an isolated population is a substantially purepopulation of cells as compared to the heterogeneous population fromwhich the cells were isolated or enriched from.

The term “substantially pure”, with respect to a particular cellpopulation, refers to a population of cells that is at least about 65%,preferably at least about 75%, at least about 85%, more preferably atleast about 90%, and most preferably at least about 95% pure, withrespect to the cells making up a total cell population.

The terms “enriching” or “enriched” are used interchangeably herein andmean that the yield (fraction) of cells of one type is increased by atleast about 10%, at least about 20%, at least about 30%, at least about40%, at least about 50% or at least about 60% over the fraction of cellsof that type in the starting culture or preparation. Enriching andpartially purifying can be used interchangeably.

The population of cells can be enriched using different methods such asmethods based on markers such as cell surface markers (e.g. FACS sortingetc).

The term “subject” as used herein includes all members of the animalkingdom including mammals such as and including a primate such as human,monkey or ape, a dog, cat, cow, horse, goat, pig, rabbit, sheep or arodent such as a rat, or mouse, and suitably refers to a human.

The terms “treat”, “treating”, “treatment”, etc., as applied to anisolated cell, include subjecting the cell to any kind of process orcondition or performing any kind of manipulation or procedure on thecell. As applied to a subject, the terms refer to providing medical orsurgical attention, care, or management to a subject.

The term “treatment” as used herein as applied to a subject, refers toan approach aimed at obtaining beneficial or desired results, includingclinical results and includes medical procedures and applicationsincluding for example pharmaceutical interventions, surgery,radiotherapy and naturopathic interventions as well as test treatmentsfor treating joint/bone disorders. Beneficial or desired clinicalresults can include, but are not limited to, alleviation or ameliorationof one or more symptoms or conditions, diminishment of extent ofdisease, stabilized (i.e. not worsening) state of disease, preventingspread of disease, delay or slowing of disease progression, ameliorationor palliation of the disease state, and remission (whether partial ortotal), whether detectable or undetectable.

As used herein, the terms “administering”, “implanting” and“transplanting” are used interchangeably in the context of deliveringcells tissues and/or products described herein into a subject, by amethod or route which results in at least partial localization of theintroduced cells at a desired site. The cells can be implanted directlyto a joint, or alternatively be administered by any appropriate routewhich results in delivery to a desired location in the subject where atleast a portion of the implanted cells or components of the cells remainviable.

In understanding the scope of the present disclosure, the term“comprising” and its derivatives, as used herein, are intended to beopen ended terms that specify the presence of the stated features,elements, components, groups, integers, and/or steps, but do not excludethe presence of other unstated features, elements, components, groups,integers and/or steps. The foregoing also applies to words havingsimilar meanings such as the terms, “including”, “having” and theirderivatives. Finally, terms of degree such as “substantially”, “about”and “approximately” as used herein mean a reasonable amount of deviationof the modified term such that the end result is not significantlychanged. These terms of degree should be construed as including adeviation of at least ±5% of the modified term if this deviation wouldnot negate the meaning of the word it modifies.

In understanding the scope of the present disclosure, the term“consisting” and its derivatives, as used herein, are intended to beclose ended terms that specify the presence of stated features,elements, components, groups, integers, and/or steps, and also excludethe presence of other unstated features, elements, components, groups,integers and/or steps.

The recitation of numerical ranges by endpoints herein includes allnumbers and fractions subsumed within that range (e.g. 1 to 5 includes1, 1.5, 2, 2.75, 3, 3.90, 4, and 5). It is also to be understood thatall numbers and fractions thereof are presumed to be modified by theterm “about.” Further, it is to be understood that “a,” “an,” and “the”include plural referents unless the content clearly dictates otherwise.The term “about” means plus or minus 0.1 to 50%, 5-50%, or 10-40%,preferably 10-20%, more preferably 10% or 15%, of the number to whichreference is being made.

Further, the definitions and embodiments described in particularsections are intended to be applicable to other embodiments hereindescribed for which they are suitable as would be understood by a personskilled in the art. For example, in the following passages, differentaspects of the invention are defined in more detail. Each aspect sodefined may be combined with any other aspect or aspects unless clearlyindicated to the contrary. In particular, any feature indicated as beingpreferred or advantageous may be combined with any other feature orfeatures indicated as being preferred or advantageous.

2. Methods and Products

Described here are methods of producing paraxial/chondrogenic mesodermcells from human pluripotent stem cells (PSCs); of generating articularcartilage-like tissue in-vitro that expresses the articular cartilagemarker lubricin and histologically cannot be distinguished for examplefrom human cartilage tissue of the knee joint; as well as methods ofmaking a cartilage-like tissue with growth plate-like properties, whichis the second type of cartilage found in humans, and is the cartilagethat is responsible for the growth of long bones due to its propensityto undergo hypertrophy and express collagen 10. Chondrocyte cellsprepared using methods described herein are further demonstrated to bestable and maintain their articular cartilage like or growth platecartilage like properties after transplant. In addition, CD73 cellsurface marker was found to be expressed by articular chondrocytes.

It is demonstrated herein that CD73 is expressed by primary adult andfetal healthy chondrocytes as well as hESC-derived articular-likechondrocytes but is not expressed on growth plate-like chondrocytesderived from hESCs.

The methods described use, in an embodiment, serum free methods togenerate paraxial/chondrogenic mesoderm (CD73+CD105+PDGFRbeta+), as wellas organized cartilage-like tissue that resembles human cartilage forexample of the knee. Serum free methods disclosed herein are useful forcell and tissue based engineering strategies and may be used for examplefor articular cartilage replacement. These cells are also useful foridentifying molecules that may be involved in degradation of cartilagein patients with osteoarthritis, drug discovery applications whichidentify molecules that can permit expansion of these chondrocytesin-vitro for potential application to autologous chondrocytetransplantation surgeries, or drugs that may attentuate osteoarthritis.Further, access to both pluripotent stem cell-derived articular andgrowth plate-like cartilage tissues will allow for the development ofcell and tissue based therapies for treatment of osteoarthritis as wellas other joint and bone disorders.

It is demonstrated herein for example that, chondrocyte specificationcan be accomplished in a high-density culture of the paraxial mesodermpopulation in serum free media containing TGFb3, TGFb2 or TGFb1 for abrief period (e.g. 10 days). Continued or extended TGFb agoniststimulation generates cartilage tissue with articular cartilagecharacteristics (histology and gene expression), while stimulation withBMP4 induces a growth plate-like cartilage tissue containinghypertrophic chondrocytes.

Extended culture has been performed, for example for over a 12 week, orlonger optionally 14 week period, during which maturation of tissue tolubricin+ or collagen 10+ cartilage tissue was demonstrated.

Using the methods described herein co-culture-with other cells is notrequired, nor is conditioned media or a scaffold, although these can beused in some embodiments.

CD73 expression, a cell surface marker, is demonstrated to mark healthyprimary adult and fetal articular chondrocytes but is not expressed inadult growth plate chondrocytes of the iliac crest. Similar to primaryhealthy articular chondrocytes, hESC-derived articular-like chondrocytes(TGFB3-treated) express CD73. Conversely, hESC-derived growth plate-likechondrocytes (BMP4-treated) express significantly less CD73. This markercan be used to distinguish these two chondrocyte sub-populations, whereCD73 is expressed by both primary and hESC-derived articularchondrocytes but is not expressed (substantially) on growth plate likechondrocytes.

Accordingly, an aspect disclosed includes a method for generatingchondrocytes and/or cartilage, optionally articular likenon-hypertrophic chondrocyte cells and/or cartilage like tissue and/orhypertrophic chondrocyte like cells and/or cartilage like tissue, themethod comprising:

-   (a) culturing a primitive streak-like mesoderm cell population,    optionally a CD56+ and/or PDGFRalpha+ primitive streak-like mesoderm    population, with a paraxial mesoderm specifying cocktail comprising:    -   (i) a FGF agonist;    -   (ii) a BMP inhibitor, optionally Noggin, LDN-193189,        Dorsomorphin; and    -   (iii) optionally one or more of a TGFbeta inhibitor, optionally        SB431542; and a wnt inhibitor;

    to specify a paraxial mesoderm population expressing cell surface    CD73, CD105 and/or PDGFR-beta;-   (b) generating a chondrocyte precursor population comprising:    -   (i) culturing the paraxial mesoderm population expressing CD73,        CD105 and/or PDGFR-beta at a high cell density in a serum free        or serum containing media;    -   (ii) culturing the high cell density CD73+, CD105+ and/or        PDGFRbeta+ paraxial mesoderm population with a TGFbeta agonist        in serum free media to produce a high cell density Sox9+,        collagen 2+ chondrocyte precursor population; and-   (c) either:    -   (i) culturing the high cell density Sox9+, collagen 2+        chondrocyte precursor population with the TGFbeta agonist for an        extended period of time to produce articular like        non-hypertrophic chondrocyte cells and/or cartilage like tissue;        or    -   (ii) culturing the high cell density Sox9+ collagen2+        chondrocyte precursor population with a BMP4 agonist for an        extended period of time to produce hypertrophic chondrocyte like        cells and/or cartilage like tissue.

In an embodiment, the TGFbeta agonist is selected from TGFb1, TGFb2,TGFb3 and/or combinations thereof. In an embodiment, the TGFbeta agonistis TGFb1.

In methods described herein, the agonist, inhibitor or component can beadded on day 1 of a time period for a specific time period or addedrepeatedly during a time period for example with media changes. Forexample, FGF is required for example at day 4 and is added with culturemedia replacement until day 15.

In an embodiment, the media used in one or more or all steps is serumfree. It is demonstrated that a wnt antagonist (e.g. a wnt pathwayinhibitor) can increase CD73 and CD105 expression when inducing aprimitive streak mesoderm population derived from induced PSCs.

In an embodiment the method is for generating articular likenon-hypertrophic chondrocyte like cells and/or cartilage like tissue,and step c) comprises culturing the high cell density Sox9+, collagen 2+chondrocyte precursor population with the TGFbeta agonist for anextended period of time to produce an articular like non-hypertrophicchondrocyte cells and/or cartilage like tissue.

In another embodiment, the BMP4 agonist is BMP4.

In another embodiment the method is for generating hypertrophicchondrocyte like cells and/or cartilage like tissue, and step c)comprises culturing the high cell density Sox9+ collagen2+ chondrocyteprecursor population with a BMP4 agonist for an extended period of timeto produce a hypertrophic chondrocyte like cells and/or cartilage liketissue.

In an embodiment, the TGFbeta inhibitor is selected from SB431542 A83-01, D 4476, GW 788388, LY 364947, RepSox, SB 431542, SB 505124, SB525334, SD 208 (e.g. any inhibitor of receptors ALK4 and ALK7 and/orTGF-βRl).

The primitive streak like mesoderm that is contacted with mesodermspecifying cocktail is for example CD56+ and PDGFRalpha+ but does notexpress cardiomyocyte specific precursor differentiation markers.

In an embodiment, of the mesoderm specifying cocktail comprises aTGFbeta inhibitor, optionally SB431524.

In an embodiment, the primitive streak-like mesoderm cell population iscultured with the TGFbeta inhibitor for at least 2 days (optionallyT3-5), 3 days or 4 days.

In an embodiment, the mesoderm specifying cocktail further comprises aWnt inhibitor, optionally DKK1, IWP2, or XAV939. In an embodiment, a Wntinhibitor is added if for example the percentage of cells expressingCD73 and CD105 or PDGFRbeta is less than 70%, less than 60%, 50%, lessthan 40%, less than 30% or less than 20%.

The percentage of cells expressing CD73 and CD105 or PDGFRbeta canincrease if a Wnt antagonist is used for example for about two daysduring stage 2 of differentiation. In an embodiment, the mesodermspecifying cocktail comprises a wnt inhibitor, optionally for 2 days, 3days or 4 days.

In an embodiment, the starting primitive streak like mesoderm populationis induced by about day 4 (e.g. KDR+/PDGFRalpha+ cells appear forexample at day 5), which for example induces the CD73, CD105 andPDGFR-beta markers to be upregulated in response to BMP inhibition andFGF during the paraxial mesoderm specification phase.

In an embodiment, the paraxial mesoderm population is comprised inembryoid bodies, monolayer culture and/or a combination thereof.

The paraxial mesoderm population can be isolated from any culture,including from an inefficient differentiation, using cell sortingmethods based on the expression of the cell surface markers, includingfor example CD73 and CD105 and/or PDGFR-beta. For example, by enrichingfor CD73, CD105 and PDGFRbeta cells. The paraxial mesoderm populationcan also be produced from induced pluripotent stem cells (iPSCs)obtained from a subject.

Accordingly, a further aspect includes a method for generatingchondrocytes and/or cartilage, optionally articular likenon-hypertrophic chondrocyte cells and/or cartilage like tissue and/orhypertrophic chondrocyte like cells and/or cartilage like tissue, themethod comprising:

-   (a) culturing a starting population of pluripotent stem cells with a    primitive streak inducing cocktail to induce a primitive streak-like    mesoderm population expressing CD56 and PDGFR-alpha;-   (b) culturing a primitive streak-like mesoderm population with a    paraxial mesoderm specifying cocktail comprising:    -   (i) a FGF agonist;    -   (ii) a BMP inhibitor; optionally Noggin, LDN-193189,        Dorsomorphin; and    -   (iii) optionally one or more of a TGFbeta inhibitor, optionally        SB431524; and a wnt inhibitor;

    to specify a paraxial mesoderm population expressing cell surface    CD73, CD105 and/or PDGFR-beta;-   (c) generating a chondrocyte precursor population comprising:    -   (i) culturing the paraxial mesoderm population expressing cell        surface CD73, CD105 and/or PDGFR-beta at a high cell density,        optionally in serum free or serum containing media;    -   (ii) culturing the high cell density CD73+, CD105+ and/or        PDGFRbeta+ paraxial mesoderm population with a TGFbeta agonist        in serum free media to produce a high cell density Sox9+,        collagen 2+ chondrocyte precursor population; and-   (d) either    -   (i) culturing the high cell density Sox9+, collagen 2+        chondrocyte precursor population with a TGFbeta agonist for an        extended period of time to produce an articular like        non-hypertrophic chondrocyte cell and/or cartilage like tissue;        or    -   (ii) culturing the high cell density Sox9+ collagen2+        chondrocyte precursor population with a BMP4 agonist for an        extended period of time to produce a hypertrophic chondrocyte        like cell and/or cartilage like tissue.

In an embodiment, the method is for generating articular likenon-hypertrophic chondrocyte like cells and/or cartilage like tissue andstep d) comprises culturing the high cell density Sox9+, collagen 2+chondrocyte precursor population with a TGFbeta agonist, optionallyTGFbeta1, 2 and/or 3, for an extended period of time to produce anarticular like non-hypertrophic chondrocyte like cell and/or cartilagelike tissue. TGFbeta agonist used in different steps can be the same ordifferent. In an embodiment, the TGFbeta agonist used to generate achondrocyte precursor population is the same TGFbeta agonist used for anextended period of time to produce an articular like non-hypertrophicchondrocyte cell and/or cartilage like tissue. In another embodiment,the TGFbeta agonist used to generate a chondrocyte precursor populationis a different TGFbeta agonist than that used for an extended period oftime to produce an articular like non-hypertrophic chondrocyte celland/or cartilage like tissue.

In another embodiment, the method is for generating hypertrophicchondrocyte like cells and/or cartilage like tissue, and comprisesculturing the high cell density Sox9+ collagen2+ chondrocyte precursorpopulation with a BMP4 agonist for an extended period of time to producehypertrophic chondrocyte like cells and/or cartilage like tissue.

In an embodiment, the primitive streak inducing cocktail comprises anodal agonist, such as activin A, a BMP4 agonist, a FGF agonist and awnt agonist.

According to the methods disclosed herein there are typically up to 4“stages” for generating chondrocytes and/or articular like cartilage andhypertrophic cartilage, depending on the stage of the startingpopulation, and include 1. Primitive streak induction; 2. Paraxialmesoderm specification; 3. Generation of chondrocyte like cells and 4.Generation of cartilage like tissue. Depending on the startingpopulation, the method can also include a stage 0 which comprisesgeneration of induced pluripotent stem cells from a somatic cell,generating aggregations of PSCs either by making embryoid bodies fromhPSCs in culture or by generating a single cell suspension from hPSCs inculture in the presence or absence of self-renewing culture media,

The methods described herein are in an embodiment for generatingchondrodcytes and cartilage tissues from human ESC and tissues. Anembodiment comprising these stages is described in further detail below.

Stage 1 - Primitive Streak Induction

Human primitive streak mesoderm is induced by contacting the pluripotentcells with primitive streak inducing cocktail for example with activin,BMP4 and basic FGF, for example on and/or between days 1 and 4 ofdifferentiation In some embodiments, the contacting is during days 1-3for example if the CD56+/PDGFRa+ population is generated sooner. In celllines and starting populations where endogenous Wnt signaling is absentor low Adding a Wnt agonist can improve the efficiency of primitivestreak formation from PSCs, and blocking Wnt signaling with anantagonist inhibit primitive streak formation. Endogenous Wnt signaling,is for example sufficient in cell lines described in the Examples (e.g.HES2). It was found using an iPSC line that a Wnt agonist improveddevelopment of a CD56+PDGFRa+ primitive streak-like population whenadded from day 1 to day 3.

In an embodiment, the wnt agonist is Wnt3a or a GSK-3 selectiveinhibitor such as CHIR-99021 (Stemolecule™ CHIR99021 Stemgent),6-Bromolndirubin-3′-Oxime (BIO) (Cayman Chemical (cat:13123)), orStemolecule™ BIO from Stemgent (cat:04003).

Brachyury expression is also induced during this time, as monitored bygene expression on approximately day 2-3, and the expression of cellsurface markers PDGFRa and CD56 by day 4. In human PSCs, PS-likemesoderm induction relies on activin and wnt signaling (see for example,19 20), and is monitored by Brachyury and PDGFRa expression. CD56 canfor example be used to monitor for example human primitive streak cellformation.

Stage 2 - Paraxial Mesoderm

The next stage is the generation of paraxial mesoderm, characterized bythe expression of transcription factors Meox1 and Nkx3.2. The primitivestreak (PS)-like cells can for example be specified to a paraxial fatein monolayer culture, and during this stage (e.g. day 4-6), BMPsignaling can be inhibited using a small molecule such as Dorsomorphin,and TGFb signaling can be inhibited using a small molecule such asSB431542. Human paraxial mesoderm requires the addition of FGF (such asbFGF) and it is added to culture media for example, between days 4 and15 of monolayer culture. A wnt antagonist is also added in someembodiments. The emergence of human paraxial mesoderm is marked by theexpression of cell surface markers including CD73, CD105, and PDGFRbeta.

Human paraxial mesoderm can be specified with the BMP inhibitorDorsomorphin (e.g. days 4-6) and bFGF during for example a monolayerculture between days 4 and 15 of differentiation. Day 15 human paraxialmesoderm is characterized by the expression of cell surface markersCD73, CD105, PDGFRbeta and Meox1 and Nkx3.2 gene expression on day 15.Expression of these markers begins for example at day 12 and is maximalfor example around day 15.

Stage 3 - Generation of Chondrocytes and Stage 4- Generation of Tissues

Paraxial mesoderm for example from day 15, can be plated directly into ahigh cell density cartilage tissue formation assay such as A micromassor filter culture. Chondrogenesis is induced in one embodiment with TGFbagonist, for example by culturing with TGFb3 for about 10 days to about2 weeks, and is characterized by the expression of Sox9 and Collagen 2.A switch to BMP4 agonist such as BMP4 or GDF containing media induces ahypertrophic chondrocyte phenotype. Extended TGFb agonist, optionallywith TGFb1 or TGFb3, treatment induces an articular chondrocyte likephenotype in hESC-derived chondrocytes and cartilage tissues, and, GDF5also induces a hypertrophic phenotype.

Chondrocytes from human paraxial mesoderm are generated by the platingof day 15 CD73+/CD105+ or CD73+/PDGFRbeta+ cells at a high cell densitydirectly in micromass or filter cultures in serum free media containinga TGF agonist such as TGFb1 or TGFb3. Cartilage tissues are generatedduring this high cell density culture phase by the extended treatmentwith TGFb agonist or BMP4 agonist.

Any human embryonic stem cell population can be used as the startingpopulation including induced pluripotent stem cell populations. In anembodiment, the starting population is a human embryonic stem cellpopulation (hESC) or an induced pluripotent stem cell population(iPSCs), optionally primary hESC and/or primary iPSC. Many human ESClines are commercially available and listed for example on the NIH HESCregistry. In an embodiment, the human ESC population is a cell lineoptionally selected from a HES2, H1, H9, or any NIH ESC Registryavailable hESC cell line; or any human iPS cell line, such as anycommercially available iPS cell lines for example as available fromSystem Biosciences.

In an embodiment, the starting population is aggregated into embryoidbodies. In another embodiment, the starting population is cultured in amonolayer.

In an embodiment, the starting population is contacted with theprimitive streak inducing cocktail for about 1 to about 5 days and priorto cardiomyocyte specification. In an embodiment, the primitive streakinducing cocktail comprises an activin agonist, optionally activin A ornodal, a BMP4 agonist, optionally BMP4, BMP2, BMP6, BMP7 and/or, BMP10,and a FGF agonist, optionally bFGF, FGF2, FGF4, FGF9 and/or optionallyFGF 19, 21, 3, 5, 6, 8a, 16-18, 20 and/or 23. In an embodiment, theprimitive streak inducing cocktail further comprises a wnt agonist,optionally selected from Wnt3a and a GSK3b inhibitor such as such asCHIR-99021 (Stemolecule™ CHIR99021 Stemgent), 6-Bromolndirubin-3′-Oxime(BIO) (Cayman Chemical (cat:13123)), and/or Stemolecule™ BIO fromStemgent (cat:04003).

The primitive streak-like mesoderm population expresses both CD56 andPDGFRalpha, as measured for example by flow cytometry (FIG. 1B). In somecell lines, the induction takes from T1 (day 1) to T4 (as in the case ofthe HES2 hESC line used in the Examples). In other cell lines, such asiPSCs for example, this induction may only require two days (fromT1-T3). The appearance of cell surface markers such as CD56 andPDGFRalpha indicates that stage 1 is complete and stage 2 can begin.

hiPSCs were differentiated with the following modifications of theprotocol shown in FIG. 1A; the Wnt pathway agonist CHIR99061 (1micromolar) was added to the stage 1 cultures and stage 1 was shortenedfrom 3 to 2 days. The paraxial mesoderm fate was specified in themonolayer cultures by treatment with Dorsomorphin (DM) and SB431542 fromday 3 to day 5, and FGF from day 3 to day 14 (Stage 2).

In an embodiment, the iPSCs receive a 3 day induction, and in anotherembodiment, an iPSC population receives a two day induction. In anembodiment an hESC population receives a 2 day induction and in anotherembodiment, the hESC population receives a 3 day induction.

Stage 2 can be considered two steps, which results in the generation ofa population marked by the expression of CD73, CD105, and/or PDGFR-beta.The cells can be plated in a monolayer culture in the presence of a BMPinhibitor (e.g. such as Dorsomorphin) and a FGF agonist such as basicFGF. Dorsomorphin is effective in inhibiting cardiomyocytespecification, for example, between the window of day 4 to day 6(T4-T6), and treatment with Dorsomorphin can be limited to this two dayperiod. FGF agonist, optionally basic FGF, is required for example, forthe duration of the monolayer culture to specify the mesoderm populationto a paraxial mesoderm fate.

Accordingly, in an embodiment, the paraxial mesoderm is specified in amonolayer culture.

In another embodiment, the BMP inhibitor is a type 1 BMP receptorinhibitor and/or soluble BMP receptors, optionally selected fromdorsomorphin (DM), noggin, Chordin, LDN-193189, soluble BMPR1a, and/orsoluble BMPR1b.

In another embodiment, the primitive streak-like mesoderm population iscontacted with the BMP inhibitor for about 1, 2, 3 or 4 days to inhibitcardiomyocyte specification.

In an embodiment, the FGF agonist for specifying the primitivestreak-like mesoderm population and/or the paraxial mesoderm populationis selected from FGF2, bFGF, FGF4 and/or FGF9.

As mentioned, the emergence of this paraxial mesoderm can be monitoredby detecting the expression of CD73, CD105 and/or PDGFR-beta on the cellsurface (observed by flow cytometry for example as shown in FIGS. 2B,3A). When a population of mesoderm that expresses these 3 markersemerges (by day 15/T15), this stage ends. FIG. 3A shows the upregulationof these markers between T12 and T15. These markers are not expressed ona significant portion of cells between T4 and T10. Over the course ofmonolayer differentiation (e.g. T4-T15) an upregulation of Meox1 andNkx3.2, two transcription factors expressed in paraxial mesoderm andsomites are detected. Expression of these markers in cultures forexample by day 15 indicates that paraxial mesoderm has been generated.

In an embodiment, the primitive streak-like mesoderm population iscontacted with the FGF agonist for at least 5 days, 6 days, 7 days, 8days, 9 days, 10, days, 11 days, 12 days or more (for example fromT3-T14) to increase the proportion of cells expressing CD73 and/or CD105for example, by at least 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60% or65% compared to FGF agonist untreated cells.

In an embodiment, the paraxial mesoderm population also expressestranscription factors Meox1 and Nkx3.2 and is negative for Nkx2.5.

The paraxial mesoderm population can be plated in any high cell densityformat, including for example in a micromass culture, pellet culture orfilter culture. For example to generate micromass tissues typicallybetween about 200,000 to about 500,000 cells are plated in one 20microliter ‘spot’ to start the tissue formation. Any more cells and theywill not adhere due to lack of area available in the spot/tissue cultureplastic area, less cells and the ‘spot’ will not be confluent withcells. As another example, in membrane filter cultures the minimumplating is about 500,000 cells, and the maximum is about 2 million cellsper 12 mm diameter filter.

In an embodiment, the paraxial mesoderm population is plated at a celldensity between 10 million cells/ml and 50 million cells/ml, optionallyat least 10 million cells per 1 ml, 20 million cells/ml, 30 millioncells/ml, 40 million cells/ml or 50 million cells/ml for example in amicromass culture. In an embodiment, between about 500,000 and 2 millioncells, optionally about 500,000, about 750,000, about 1 million, about1.25 million, about 1.5 million, about 1.75 million, about 2 millioncells are plated in a 12 mm diameter membrane filter culture.

In certain embodiments, serum free methods are used for example togenerate CD73+CD105+PDGFRBeta+ paraxial mesoderm from a primitivestreak-like mesoderm population using for example bFGF and BMPinhibition.

In an embodiment, optionally during stages 3 and/or 4 the media is serumfree and comprises a base media optionally high glucose DMEM +dexamethasone, ascorbic acid, insulin, transferrin, selenium, andproline. An example of a base media is provided for example in reference18.

As used herein, a base media refers to a mixture of salts that providecells with water and certain bulk inorganic ions essential for normalcell metabolism, maintain intra- and extra-cellular osmotic balance,provide a carbohydrate as an energy source, and provide a bufferingsystem to maintain the medium within the physiological pH range.Examples of base medias include, but are not limited to, Dulbecco’sModified Eagle’s Medium (DMEM), Minimal Essential Medium (MEM), BasalMedium Eagle (BME), RPM1 1640, Ham’s F-10, Ham’s F-12, alpha-MinimalEssential Medium (aMEM), Glasgow’s Minimal Essential Medium (O-MEM), andIscove’s Modified Dulbecco’s Medium(IMDM), Stem Pro and mixturesthereof. In one particular embodiment, the basal salt nutrient solutionis an approximately 50:50 mixture of DMEM and Ham’s F12. In anembodiment, the base media is high glucose DMEM .

In another embodiment, the media comprises a base media comprisinginsulin, transferrin and optionally selenium in combination with DMEM,Stem Pro@, Mesofate (Stemgent), RMPI 1640 or IMDM.

It is contemplated that the media and/or compositions can furthercomprise trace elements. Trace elements can be purchased commercially,for example, from Mediatech. Non-limiting examples of trace elementsinclude but are not limited to compounds comprising, aluminum, chlorine,sulfate, iron, cadmium, cobalt, chromium, germanium, sodium, potassium,calcium, phosphate and magnesium. Specific example of compoundscontaining trace elements include but are not limited to, AlCl₃, AgNO₃,Ba(C₂H₃O₂)₂, CdCl₂, CdSO₄, CoCl₂, CrCl₃, Cr₂(SO₄)₃, C_(U)SO₄, ferriccitrate, GeO₂, Kl, KBr, LI, molybdic acid, MnSO₄, MnCl₂, NaF, Na₂SiO₃,NaVO₃, NH₄VO₃, (NH₄)₆Mo₇O₂₄, NiSO4, RbCI, selenium, Na₂SeO₃, H₂SeO₃,seleniteNa, selenomethionone, SnCl₂, ZnSO₄, ZrOCl₂, and mixtures andsalts thereof.

It is contemplated that amino acids can be added to the defined media.Non-limiting examples of such amino acids are Glycine, L-Alanine,L-Alanyl-L-Glutamine, L-Glutamine/Glutamax, L-Arginine hydrochloride,L-Asparagine, L-Aspartic acid, L-Cysteine, L-Glutamic Acid, L-Histidine,L-Isoleucine, L-Leucine, L-Lysine hydrochloride, L-Methionine,L-Phenylalanine, L-Proline, L-Hydroxyproline, L-Serine, L-Threonine,L-Tryptophan, L-Tyrosine and L-Valine. In certain embodiments, the aminoacid is L-Isoleucine, L-Phenylalanine, L-Proline, L-Hydroxyproline,L-Valine, and mixtures thereof.

It is also contemplated that the base media can comprise ascorbic acid.

In addition, the compositions and methods may also comprise othercomponents such as albumin, transferrin, L-glutamine, lipids,antibiotics, betaMercaptoethanol, vitamins, minerals, ATP and similarcomponents may be present. In another specific embodiment, thecompositions and methods comprise vitamin D₃ and ATP.

In an embodiment, the high cell density spot is maintained for about 0to 4 days, for example the paraxial mesoderm population is cultured athigh cell density for about 0 to about 4 days, optionally 0, 1, 2, 3, or4 days before addition of TGFbeta3 agonist.

In an embodiment, the CD73+, CD105+ and/or PDGFRbeta+ paraxial mesodermpopulation is cultured with the TGFbeta agonist in serum free media forat least 3 days, or for about 3 days to about 14 days, optionally atleast a week, to produce a Sox9+, collagen 2+ chondrocyte precursorpopulation.

As demonstrated herein, extended TGFbeta signaling can result ingeneration of an articular like cartilage tissue. In an embodiment, theextended period of time the Sox9+, collagen 2+ chondrocyte precursorpopulation is cultured with a TGFbeta agonist is at least 4 weeks, 5weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks,13 weeks, 14 weeks or more to produce an articular cartilage liketissue. In an embodiment, the chondrocyte precursor population iscultured with the TGFb agonist until lubricin and/or cartilageintermediate layer protein 2 (CILP2) is expressed. In an embodiment, theparaxial mesoderm population and/or the Sox9+, collagen 2+ chondrocyteprecursor population is cultured with a TGFb agonist selected fromTGFb3, TGFb2 and/or TGFb1.

Switching the culture from comprising TGFb agonist to BMP agonist,induces a hypertrophic chondrocyte population that is growth plate like.In an embodiment, the hypertrophic chondrocyte like cells and/orcartilage like tissue, is cultured with the BMP4 agonist to produce acollagen 10+ and/or Runx2+ hypertrophic chondrocyte like cellsand/orcartilage like tissue. In an embodiment, the extended period oftime the high cell density Sox9+ collagen2+ chondrocyte precursorpopulation is cultured with the BMP4 agonist, optionally BMP4 or GDF5,is at least 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8weeks, 9 weeks, 10 weeks, 11 weeks, 12 weeks, 13 weeks, 14 weeks or moreto generate a cartilage tissue that expresses collagen 2 and/or ahypertrophic chondrocyte population that expresses collagen 10.

For example, stage 3 can comprise a 2-3 day ‘spotting’ phase which canbe done in 2% serum containing media, or serum free. This allows a highcell density of cells to adhere to a small area for example of a tissueculture dish or membrane filter. At the end of this stage of optionally3 days (+3 days), the majority and/or substantially all cells in themicromass express CD73, CD105, and PDGFRbeta. In an embodiment, thisstep is followed by TGFB agonist treatment in serum free media for aperiod of time that is optionally at minimum about 1 week (e.g. at +10days, the culture is at day 25). By about two weeks (from about 10 toabout 14 days), early chondrocyte genes are expressed such as Sox9 andCollagen 2. The cultures can either be maintained in TGFb agonist suchas TGFb3 for example over a period of several weeks to several months togenerate an articular cartilage (AC) like tissue (e.g. stage 4).Upregulation of the AC gene lubricin is detected for example after about5-10 weeks of micromass culture.

Histological analyses over this extended period of time shows thegeneration of higher quality tissue with longer culture, for exampleafter 12 weeks compared to 6 weeks.

The generation of hypertrophic growth plate-like cartilage tissue isachieved by the switching of TGFb agonist containing media to a mediacontaining BMP4 agonist instead. The BMP4 agonist switch typically takesplace at about day 25 after the cells have been stimulated with TGFbagonist such as TGFb3 for at least 1 week. This switch causes themicromass cells to convert to a hypertrophic chondrocyte phenotype,which is an enlarged cell (e.g. see FIG. 4C) that expresses genesassociated with growth plate differentiation (e.g. collagen 10 andRunx2).

It has been found that immediate stimulation with BMP4 at about 3 daysof micromass (when TGFb3 agonist is usually added) results in themicromasses balling up, becoming non-adherent, and/or not survivingand/or making tissue. A switch to BMP4 anytime for example between about10 days and 6 weeks of stage 3 culture is able to induce thishypertrophic response in TGFb agonist treated micromasses. In anembodiment, the switch to BMP4 agonist, optionally BMP4 is on about day25 to generate growth plate like cartilage.

Collagen 10 expression, indicative of growth plate hypertrophicchondrocytes is expressed for example after several weeks (e.g. 9-12weeks in the cell line in Example 1); similar timing wise to lubricin inTGFb agonist treated micromasses. Thus, extended BMP4 agonist treatmentresults in the generation of collagen 10 expressing growth plate-likecartilage tissue from hPSCs.

Accordingly, in an embodiment, the chondrocyte precursors are culturedin TGFbeta agonist or BMP4 agonist for cartilage tissue formation.

The desired populations at one or more stages can be enriched. Forexample, the CD73+ CD105+ cells and/or CD73+ PDGFR-beta+ can beisolated, optionally by flow cytometry, from the paraxial mesodermpopulation expressing cell surface CD73, CD105 and/or PDGFR-beta priorto high cell density culture.

The methods described can also be used for example on chondrocyteprecursor cells that have been generated using other methods and/or thatare isolated from a subject.

Accordingly, in another aspect, the disclosure includes a method ofgenerating chondrocyte like cells comprising:

-   (a) culturing chondrocyte precursor cells at a high cell density, in    serum free or serum containing media;-   (b) culturing the high cell density the chondrocyte precursor cells    with a TGFbeta agonist in serum free media; and-   (c) either    -   (i) culturing the chondrocyte precursor cell with a TGFbeta        agonist for an extended period of time to produce an articular        cartilage like chondrocyte population; or    -   (ii) culturing the chondrocyte precursor cell with a BMP4        agonist for an extended period of time to produce a hypertrophic        chondrocyte population of cells and/or cartilage like tissue.

In an embodiment, the chondrocyte precursor cells are primary fetalchondrocytes or passaged fetal chondrocytes. In another embodiment, thechondrocyte precursor cells are primary cells obtained from a subjectwith a cartilage or bone condition or disease. Cells obtained from asubject can be subjected to methods to induce pluripotency prior to highcell density culture. For example, primary chondrocytes can be isolatedfrom patients and tested directly using the micromass methods, or anysomatic cell from a patient can be used to make patient specific IPScells which would then be differentiated using the 4 stages of themethod described herein to generate cartilage tissues. Cells obtainedfrom a subject for example from a disease site can be used to test forameliorating drugs and/or cultured for example where the subject hasosteoarthritis, with synovial fluid components or other test substancesto try to identify components that propagate and/or ameliorate one ormore symptoms. Cells or fluid components can also be obtained from asubject, for example from a non-disease site and used to generate cellsand/or tissue for autologous chondrocyte implantation for examplewherein the generated cells and/or tissues are administered to asubject. In an embodiment, the cells are used for allografttransplantation.

The steps can be performed in vitro. Alternatively, cells and/orcompositions comprising the cells or tissue can be administered forexample prior to full cartilage like tissue formation to a subject andmonitoring for cartilage formation in vivo. For example, cells preparedusing a method described herein and optionally dissociated prior toadministration.

The methods can also be employed to generate a paraxial mesodermpopulation of cells. In an embodiment, the method comprises:

-   (a) culturing a starting population of pluripotent stem cells with a    primitive streak inducing cocktail to induce a primitive streak-like    mesoderm population expressing CD56 and PDGFR-alpha;-   (b) culturing a primitive streak-like mesoderm population with a    paraxial mesoderm specifying cocktail comprising:    -   (i) a FGF agonist;    -   (ii) a BMP inhibitor; optionally Noggin, LDN-193189, or        Dorsomorphin; and    -   (iii) optionally one or more of a TGFbeta inhibitor, optionally        SB431524; and /or a Wnt inhibitor, optionally DKK1, IWP2, or        XAV939;

    to specify a paraxial mesoderm population expressing cell surface    CD73, CD105 and PDGFR-beta.

In an embodiment the method further comprises enriching CD73, CD105and/or PDGFRbeta expressing cells.

In an embodiment, the concentration of a component (e.g. agonist,inhibitor, etc.) used is an effective amount, for example effective toinduce the expression of a marker indicative of the desired cell type.

In an embodiment, the FGF agonist is a FGF.

In an embodiment, the concentration of FGF is any concentration betweenabout 2 ng/mlto about 100 ng/ml, optionally about 20 ng/ml.

In an embodiment, the BMP inhibitor is Dorsomorphin (DM).

In an embodiment, the concentration of DM is any concentration betweenabout 0.5 uM and about 5uM, optionally about 4 uM (e.g.micromolar).

In an embodiment, the TGFb agonist is TGFb1, 2 and/or 3.

In an embodiment, the concentration of TGFb1, 2 and/or 3 is anyconcentration between about 1 ng/ml and about 50 ng/ml, optionally about10 ng/ml.

Any number between a specified range includes for example every 0.1 orevery 0.5 unit increment

In an embodiment, the concentration of TGFbeta3 is any concentrationbetween about 1 ng/ml and about 50 ng/ml, optionally about 10 ng/ml.

In an embodiment, the BMP4 agonist is BMP4.

In an embodiment, the concentration of the BMP4 is any concentrationbetween about 10 ng/ml and about 100 ng/ml, optionally about 50 ng/ml.

Methods can also include a step of monitoring, optionally in vitro or invivo, for proteoglycan production, and/or calcification and/ormineralization, for example by Von Kossa staining. For example von Kossastaining can be used to confirm mineralization and indicates thedevelopment of growth plate like cartilage.

A further aspect of the disclosure includes a population of cells ortissue generated using a method described herein, optionally for use fora utility described herein.

Accordingly provided is an isolated population of chondrocyte likecells, optionally articular like non-hypertrophic chondrocyte like cellsand/or cartilage like tissue and/or hypertrophic chondrocyte like cellsand/or cartilage like tissue, or precursor population generatedaccording to a method described herein.

In an embodiment, the isolated population is a paraxial mesodermpopulation expressing cell surface CD73, CD105 and PDGFR-beta.

In an embodiment, the isolated population of chondrocyte like cellscomprise cells expressing one or more chondrocyte markers and/or genes,for example GDF5, WNT9A, and/or ERG similar to joint interzone cells,lubricin Meox1 and/or CIP2 similar to articular chondrocytes, or RUNX2,SP7, alkaline phosphatase (ALP/ALPL), and/or COL10A1 similar tohypertrophic chondrocyte cells.

A further aspect is a composition comprising the population of articularlike non-hypertrophic chondrocyte like cells and/or cartilage liketissue and/or hypertrophic chondrocyte like cells and/or cartilage liketissue, and/or precursor cells generated according to a method describedherein; and a carrier. Depending on the use, the carrier can beoptionally Polyethylene glycol (PEG), hydrogel, bone scaffolding, bonesubstitute scaffolding and/or matrigel. Other carriers include forexample carrier comprises one or more of a group consisting of sodiumhyaluronate, hyaluronic acid and its derivatives, gelatin, collagen,chitosan, alginate, buffered PBS, Dextran and polymers. For example, thecarrier can be a carrier that is suitable for use in transplantationapplications e.g. pharmaceutical grade carriers. The carrier can also besuitable for stabilizing the cells for transport and/or storage. Cellscan for example be cryofrozen and/or tissues can be shipped at roomtemperature and/or any between room temperature and about 4° C.

The composition can for example be in a slurry comprising dissociatedcells for example for administration to a subject. In an embodiment, thecomposition can comprise other cells for example endothelial cellsand/or fibroblasts for example for growth plate cell/cartilagetransplantation.

A further aspect includes a cartilage or bone tissue product comprisingcells and/or tissue described herein and a scaffold or membrane. Forexample, during transplantation applications, chondrocytes can beadministered to a damaged area in combination with a membrane (e.g.tibial periosteum or biomembrane) or pre-seeded in a scaffold matrix. Inan embodiment, the scaffold is a bone substitute.

Cells and tissues generated according to the methods disclosed hereincan for example be used for ameliorating symptoms in a subject afflictedwith a joint or bone disorder.

Another aspect accordingly includes a method for ameliorating symptomsand/or treating a subject in need thereof comprising administering thepopulation of cells and/or tissues described herein and/orinserting/implanting a product comprising said cells.

Uses of the cells, tissues and products are also provided in anotheraspect. In an embodiment, the disclosure provides use of the populationof cells and/or tissues or composition or product described herein forameliorating symptoms and/or treating a subject in need thereof.

In an embodiment, the population of cells for a use or method describedherein for example that are to be administered to the subject areinduced from autologous cells.

In an embodiment, the population of cells is enriched for articular likenon-hypertrophic chondrocyte like cells and/or cartilage like tissue.

In an embodiment, the subject has a joint condition such asosteoarthritis, osteochondritis dissecans, polychondritis, and otherchondropathies, or joint injuries affecting the cartilage.

In a further embodiment, the population of cells is enriched forhypertrophic chondrocyte like cells and/or cartilage like tissue.

In yet another embodiment, the enriched hypertrophic chondrocyte likecells and/or cartilage like tissue, is adhered to a scaffold ormembrane.

In another embodiment, the subject has a bone condition such as a bonefracture, bone break or is in need of a bone replacement for example dueto a malignancy or trauma, achondroplasia, osteogenesis imperfect,osteoporosis or other osteopathies.

The generated cells can be optionally immortalized and/or modified forexample to stably express a reporter gene operably linked to a promoterof a gene typically expressed in articular chondrocyte like cells suchas lubricin promoter and/or typically expressed in hypertrophicchondrocytes such as collagen 10 promoter (e.g. reporter system) toprovide a model cell, that can for example be used for testing forcandidate substances for their ability to promote, inhibit, maintain orare active in articular chondrocytes or hypertrophic chondrocytes. Alarge number of reporter genes are known in the art including forexample fluorescent proteins such as GFP, RFP, dsRed etc, luciferase.Reporter gene assays are versatile and sensitive methods and can be usedto assay numerous candidate substances in high-throughput drug-screeningprograms.

Also provided herein are kits comprising one or more of a cell or tissuegenerated according to a method described herein, a product orcomposition comprising a cell or tissue generated, optionally comprisinga reporter system or other modification, according to a method describedherein, a combination of at least two selected from an agonist,inhibitor, media, apparatus or other component that can be used in amethod described herein and instructions for use for exampleinstructions on how to generate the cells, perform an assay oradminister the cell, tissue, composition, or product, and a vial orother container for housing one of these aforementioned cells, tissues,compositions, products, agonists, inhibitors, medias etc.

The cells and tissues generated according to a method described hereincan be used for various applications. For example the cells and tissuescan be used for predictive drug toxicology and drug discovery. Forexample, a population of enriched hPSC-derived chondrocytes, articularor growth-plate like, can be used in predictive drug toxicology screensas well as for screens aimed at identifying novel compounds that impactchondrocyte biology and physiology. Drugs which promote theproliferation, but also maintenance, of articular chondrocytes,optionally in the presence of one or more disease mediators, will be ofinterest as expansion of primary articular chondrocytes from patients inthe past has led to the dedifferentiation of the chondrocytes to amesenchymal like phenotype, and results in less than ideal cartilagereplacement.

Accordingly, an embodiment includes a method of testing a candidatechondrogenic modulating substance, the method comprising:

-   a) contacting a test substance with a chondrocyte precursor lineage    cell population, the test substance contacted with the chondrocyte    precursor lineage cell population at any step in the method    described herein;-   b) assessing the effect of the test substance on chondrocyte    proliferation, maintenance and/or differentiation compared to a    control population generated in the absence of test substance; and-   c) identifying the test substance as a candidate chondrogenic    modulating substance if the test substance increases or decreases    proliferation, and/or affects chondrocyte maintenance or    differentiation compared to the control.

The modulating substance can for example be a disease mediator or acomponent with protective activity. Disease mediators can also be usedin the presence or absence of test substances to screen for agents thatinhibit and/or reduce the disease inducing effect of the diseasemediators.

The cells and tissues are optionally used for assessing celltransplantation protocols ad may be used for cell transplantation. Forexample, these methods will allow for example comparison of: a) theeffects and efficiency of transplanting articular or growth plate likehPSC-derived chondrocytes or cartilage tissues versus autologouschondrocyte transplantation or adult mesenchymal stem cell-derivedchondrocytes or cartilage tissues, b) the effects of transplantingarticular like cartilage tissues and/or a chondrocyte-cell-slurry totreat various articular cartilage defects in animal models or patientswith varying levels of joint disease including osteoarthritis, c) theability of hESC-derived growth plate-like chondrocytes or cartilage liketissues to be used for bone regeneration (via a cartilage templateintermediate).

The cells and tissues can for example be used in tissue engineeringapplications. For example enriched populations of chondrocytes from hPSCcultures can be generated and used in engineered constructs for examplewith defined proportions of chondrocytes and other cell types orscaffolding. The hPSC-derived chondrocytes can be seeded for exampleonto a bone substitute, for example, may allow for cartilage/boneinterfaces in vitro, or in vivo. Such products can be transplanted intopatients or animals with damage to an osteo-chondral junction.

The methods can be used to establish patient-specific disease models (bygenerating iPS cell lines from patients for example for diseasescomprising a genetic component). Chondrocyte like cell and tissuepopulations can be established from human patients using methodsdescribed herein. In order to analyze the differentiation as well as thephenotypes of these diseased cells, a paraxial mesoderm population canbe generated and those cells can be specified to a chondrocyte fate, andfinally articular or growth plate like cartilage tissues using protocolsdescribed in this disclosure.

The methods described herein can also be used to establish generalmodels of cartilage disease (e.g. hypertrophy) including thoseassociated with osteoarthritis. Without wishing to be bound by theory,BMP4 may be inducing a hypertrophic fate in articular-like chondrocytesand cartilage tissues, which is a pathway which is often upregulated inarticular cartilage at the onset of osteoarthritis. As another example,the addition of factors isolated from osteoarthritis patients tocultures described herein can be used to determine whether metabolicallyactive compounds (such as those found in the fat pad in the knee of OApatients) can affect the quality of the tissue in vitro.

Also, as CD73 has been found to identify articular chondrocyte likecells, the use of CD73 by flow cytometry, and the quantitative measureof cell size indicating hypertrophy by flow cytometry, can facilitatehigh throughput screening of factors which promote articular or growthplate like fates, as well as histology of the tissue itself throughmarker based assessment methods. Hypertrophy is associated withosteoarthritis for example in mouse models, and is thought to besimilarly causative in patients. These applications could for example beused to identify modulators of hypertrophy.

In an embodiment, the candidate chondrogenic modulating substance is afactor isolated from a subject with diseased cartilage or bone. In anembodiment the factor is isolated from a fat pad in a joint, optionallya knee joint, of a subject with arthritis and/or obese or from healthysubjects as controls. In another embodiment, the test substance is addedwith the BMP4 agonist and the test substance is assessed for its abilityto inhibit hypertrophy compared to controls treated in the absence ofthe test substance. In yet another embodiment, hypertrophy is assessedusing flow cytometry, optionally by assessing forward and side scatter.

In another embodiment, the method comprises a method of assessing acandidate articular chondrocyte proliferation inducer comprising:

-   (a) obtaining articular like non-hypertrophic chondrocyte cells    and/or cartilage like tissue generated according to the method of    described herein,-   (b) culturing the articular like non-hypertrophic chondrocyte cells    and/or cartilage like tissue with a test substance;-   (c) measuring the articular like non-hypertrophic chondrocyte like    cell proliferation;-   (d) detecting an increase in proliferation compared to articular    like non-hypertrophic chondrocyte cells and/or cartilage like tissue    cultured in the absence of the test substance indicating that the    test substance is a candidate articular chondrocyte proliferation    inducer.

A further embodiment includes a method of assessing a candidatehypertrophic chondrocyte proliferation inducer comprising:

-   (a) obtaining hypertrophic chondrocyte like cells and/or cartilage    like tissue, generated according to the method described herein,-   (b) culturing the hypertrophic chondrocyte like cells and/or    cartilage like tissue, with a test substance;-   (c) measuring hypertrophic chondrocyte, cell proliferation;-   (d) detecting an increase in proliferation compared to hypertrophic    chondrocyte like cells and/or cartilage like tissue cultured in the    absence of the test substance indicating that the test substance is    a candidate hypertrophic chondrocyte proliferation inducer.

In an embodiment, CD73 articular like non-hypertrophic chondrocyte cellsand/or cartilage like tissue are isolated prior to culture with the testsubstance, optionally isolated by flow cytometry.

In another embodiment, the articular like non-hypertrophic chondrocytecell and/or hypertrophic chondrocyte like cell comprise a reporter genefunctionally coupled to an articular chondrocyte specific promoter (i.e.articular chondrocyte reporter system), optionally a lubricin promoterelement and/or a reporter gene functionally coupled to a hypertrophicchondrocyte specific promoter, optionally a collagen 10 promoter element(i.e. hypertrophic chondrocyte reporter system); and a compound thatinduces articular chondrocyte differentiation (identified by measuringthe articular chondrocyte reporter system activity) and/or a compoundthat induces hypertrophic chondrocyte differentiation (identified forexample by measuring hypertrophic chondrocyte reporter system activity).

In an embodiment, an increase in proliferation is measured using one ormore of the following methods: a 3H Thymidine incorporation assay; a5-bromo-2′-deoxyuridine (BrdU) incorporation assay; and a propidiumiodine assay.

A further embodiment includes a method of assessing AC cell and/or GPCcell toxicity or protective activity of a test compound, comprising:

-   (a) generating articular like non-hypertrophic chondrocyte cells    and/or cartilage like tissue and/or GPC like cells and/or growth    plate cartilage according to the method described herein;-   (b) culturing the articular like non-hypertrophic chondrocyte cells    and/or cartilage like tissue and/or GPC cells with the test    substance;-   (c) measuring cell toxicity and/or cell protective activity of the    test substance;-   (d) detecting an increase in cell toxicity compared to articular    like non-hypertrophic chondrocyte cells and/or GPC cells and/or    tissue cultured in the absence of the test substance indicating that    the test substance is toxic to articular chondrocyte and/or GPC    cells or detecting an increase in protective activity (e.g. a    decrease in cell toxicity) compared to articular like    non-hypertrophic chondrocyte cells and/or GPC cells and/or tissue    cultured in the absence of the test substance indicating the test    substance is protective.

In an embodiment, cell toxicity is measured using one of the followingassays: a Trypan blue dye assay; a luciferase assay; a tetrazolim saltconversion assay such as a MTT assay and a WST-1 assay.

As demonstrated herein, IL-1beta can induce osteoarthritis like changesin a cartilage cell population. II-1b and other mediators, for exampleother cytokines and knee fat pad components (e.g. disease mediators) aswell as mechanical disruption can be used in screening methods describedherein. For example, cells produced using a method described herein canbe contacted with such disease mediators or mechanical disruption in thepresence or absence of a test substance (e.g. either added prior to theaddition of the disease mediators or mechanical disruption or after thecells have been contacted and/or mechanically disrupted to assess thetest substances ability to inhibit or reverse the disease mediatorfunction.

In an embodiment, the AC like chondrocytes and/or cartilage like tissueor the hypertrophic like chondrocytes and/or cartilage like tissueis/are contacted with a disease mediator optionally prior to culturewith the test substance.

In an embodiment, the disease mediator is a cytokine, optionally IL-1beta. In another embodiment, the disease mediator is a joint fat padcomponent, optionally a knee fat pad component.

In an embodiment, the screening assay comprises one or more of thefollowing analyses or assays: histological analysis, biochemical assayssuch as those that quantify the production of glycosaminoglycans andproteoglycans, gene expression analyses, gain/loss of a fluorescentreporter such as lubricin or collagen 10 by microscopy or flowcytometry, gain or loss of CD73 cell surface receptor expression, assaysfor cell death, and flow cytometry for cell size which can indicatechondrocyte hypertrophy.

CD73 can be used as a positive selection marker for cell sortingexperiments to enrich for articular-like chondrocytes. These markerscould facilitate the isolation of articular chondrocytes from primarysources of tissue, to be used in conjunction with allogenic orautologous cartilage repair strategies currently in use.

Accordingly a further aspect includes a method of isolating articularchondrocytes comprising: contacting a mixed population of cellscomprising chondrocytes with an antibody (or other binding molecule)that binds CD73 under conditions that allow for the formation of anantibody(or other binding molecule):CD73 cell complexes; and isolatingthe antibody CD73 cell complexes. This can be done by a number of knownimmunological methods known in the art including cell sorting basedmethods.

In an embodiment the mixed population of cells comprises non chondrocytecells, non-articular chondrocyte like cells, and/or hypertrophicchondrocyte like cells.

In an embodiment, the antibody is coupled to a tag such as a bead suchas a sepharose bead or magnetic bead that for example facilitatesisolation.

The combination of CD73, CD105, and PDGFR-beta can be used as positiveselection markers for isolating paraxial/chondrogenic mesoderm fromother lineages or progenitors of other lineages. As other lineages suchas the cardiac lineage are often induced using similar protocols tothose used to generate paraxial mesoderm, isolation of paraxial mesodermby cell sorting using these cell surface markers provides a means toenrich for this population. For example, the cells are enriched usingflow cytometry.

Accordingly an embodiment includes a method of isolating paraxialchondrogenic mesoderm population of cells comprising: contacting apopulation of cells comprising paraxial chondrogenic mesoderm cells witha cocktail comprising a CD73 specific binding agent, CD105 specificbinding agent, and a PDGFRbeta specific binding agent; and enriching forCD73+, CD105+ and PDGFRbeta+ cells. In an embodiment, the binding agentis an antibody. In another embodiment, the cells are enriched using flowcytometry. Also provided is an isolated paraxial chondrogenic mesodermpopulation of cells prepared according to the method described hereinand which can be comprised in a composition or in a product as describedherein. These cells can also be used in screening assays describedherein. The paraxial mesoderm population can be used for example forgenerating other cell types for example for generating skeletal muscleprogenitors, adipocyte progenitors (fat cells) and potentially boneprogenitors (osteoblasts).

Further, the definitions and embodiments described in particularsections are intended to be applicable to other embodiments hereindescribed for which they are suitable as would be understood by a personskilled in the art. Selections and combinations of different agonists,inhibitors and/or other components including for example agonists,inhibitors, etc. recited in definitions are also contemplated. Forexample, in the following passages, different aspects of the inventionare defined in more detail. Each aspect so defined may be combined withany other aspect or aspects unless clearly indicated to the contrary. Inparticular, any feature indicated as being preferred or advantageous maybe combined with any other feature or features indicated as beingpreferred or advantageous.

The above disclosure generally describes the present application. A morecomplete understanding can be obtained by reference to the followingspecific examples. These examples are described solely for the purposeof illustration and are not intended to limit the scope of theapplication. Changes in form and substitution of equivalents arecontemplated as circumstances might suggest or render expedient.Although specific terms have been employed herein, such terms areintended in a descriptive sense and not for purposes of limitation.

The following non-limiting examples are illustrative of the presentdisclosure:

EXAMPLES Example 1 Results

Chondrocyte formation in vitro includes the induction of aprimitive-streak-like (PS) population as embryoid bodies (stage 1), thespecification of paraxial mesoderm in a monolayer culture (stage 2), thegeneration of chondrocyte progenitors in high cell density micromassculture or on collagen-coated membrane filters (stage 3), and thespecification of articular and growth plate chondrocytes and cartilagetissues in micromass or filter cultures (stage 4) (FIG. 1A).

A first step in differentiation from a pluripotent stem cell (PSC) stateis the formation of a PS population which, in the embryo, occurs duringgastrulation when the three germ layers (endoderm, mesoderm, andectoderm) are formed. The PS population and endoderm and mesodermsubsets can be induced from PSCs using a combination of Activin A(activin, a surrogate for Nodal), Wnt, and BMP signaling molecules(Nostro, Cheng et al. 2008, Kattman, Witty et al. 2011, Craft, Ahmed etal. 2013). A PS population induced with activin, BMP4 and bFGF can beobserved by the expression of cell surface markers CD56 and PDGFreceptor alpha (PDGFRa) (FIG. 1B).

hESC derived primitive streak (PS) mesoderm expresses CD56, PDGFRalphaand KDR, as shown in FIG. 1C. hIPSCs were induced to a PS mesodermpopulation using Activin A (3 ng/ml), BMP4 (1 ng/ml), basic FGF (5ng/ml) and CHIR99061 ( 1 micromolar), a small molecule Wnt agonistduring days 1 and 3 of induction. hIPSCs were induced for a two dayperiod (day 1 to day 3) instead of a three day period (day 1 to day 4)as in the case for the HES2 hES cell line (FIG. 1C). hIPSC-derived PSmesoderm also expresses CD56, PDGFRalpha and KDR (FIG. 1D), howeverthese cell surface markers are not expressed if hiPSCs are induced inthe absence of CHIR99061 (FIG. 1E).

With no additional factors beyond day 4 of culture, progenitorscontained within this population, can be specified to a cardiogenic fateas observed by co-expression of the cell surface markers KDR and PDGFRaat T5 (FIG. 2A, 0 DM, 0 FGF), and the subsequent expression of thecardiac transcription factor Nkx2.5 on day 15 (T15) (Kattman, Witty etal. 2011), FIG. 2C).

To generate chondrocytes, it is essential to first specify this PSpopulation to a paraxial mesoderm fate. Previous studies have shown thatmesoderm populations that express cell surface markers often found onmesenchymal stem cells, CD73 and CD105, have chondrogenic potential(Hwang, Kim et al. 2006). The expression of these two cell surfacemarkers, as well as the expression of transcription factors Meox1 andNkx3.2 combined with the lack of expression of Nkx2.5 to monitor theemergence of a paraxial mesoderm population was used. Previousexperiments in the mouse ESC model system have shown the importance ofinhibiting the BMP signaling pathway in the context of FGF signaling toprevent the emergence of cardiac mesoderm and promote the development ofparaxial mesoderm (Craft, Ahmed et al. 2013). The addition of theinhibitor of type I BMP receptors Dorsomorphin (DM) for a period of twodays from T4 to T6 (days 4 to 6 of differentiation) changed theexpression patterns of PDGFRa and KDR by as early as T5, as the cellsexpressed less PDGFRa than untreated mesoderm (FIG. 2A). The addition ofbFGF did not change the PDGFRa/KDR population drastically. Very fewcells in untreated mesoderm conditions expressed CD73 and CD105 (7.46%,FIG. 2B). Treatment with DM increased this population only slightly,however, treatment with FGF from day 4 until day 15 increased theproportion of cells expressing CD73 and CD105 dramatically (52%, FIG.2B). The changes in expression of these surface markers were accompaniedby the upregulation of paraxial genes Meox1 and Nkx3.2 (FIG. 2C).Treatment with both DM from T4-T6 and bFGF from T4-T15 resulted in amore robust CD73/CD105 population (67%) and even higher expression ofMeox1 and Nkx3.2 (FIG. 2C), suggesting that both BMP inhibition and FGFtreatment are required for paraxial mesoderm specification from the PSpopulation. In addition to CD73/CD105 expression, CD73-positive cellsderived from FGF- or DM+FGF-treated monolayers also expressed the PDGFreceptor beta (PDGFR-beta, PBeta), suggesting that paraxial mesodermalso expresses this cell surface marker (FIG. 2B).

During paraxial mesoderm specification in the monolayer culture, it wasobserved that Wnt pathway inhibition (during the two day period after PSmesoderm induction (days 4 to 6 for hESC, days 5 to 7 for hIPSCs))resulted in an increase in the percentage of cells expressing the cellsurface markers CD73 and CD105 on day 15 of differentiation (FIG. 2C).Thus, in some cell lines, the efficiency of paraxial mesodermspecification may be improved in the presence of a Wnt pathwayantagonist immediately following the PS mesoderm induction phase.

Previous studies have shown that TGFBeta/BMP signaling is required togenerate chondrocyte progenitors from paraxial mesoderm. It has beenfound that TGFB3 (as well as TGFbeta1 or TGFbeta2) stimulation isrequired for stage 3 (e.g. starting at day 15), as direct plating ofthis mesoderm into BMP4 containing media resulted in the development ofnon-adherent cell aggregates that did not form cartilage tissue.Following 10 days of TGFb3 treatment (day 25 total), cultures could beswitched to media containing BMP4 or maintained in TGFb3 (stage 4) inorder to specify subsets of chondrocytes (articular/non-hypertrophic orgrowth plate/hypertrophic). To determine the chondrocyte potential ofthe day 15 mesoderm populations, the cells were plated at high celldensity in a 20 microliter volume on tissue culture treated Petri dishesfor an hour (micromass) and then the ‘spot’ was submerged/covered withmedia. In our initial studies, the cells were ‘spotted’ in a mediacontaining 2% fetal bovine serum. However, this short serum exposure canbe omitted with no effects on cartilage formation at later stages,making this protocol optionally serum-free. After 2 to 3 days,serum-free media containing TGFb3 is added to the culture to generatechondrocyte progenitors. Populations derived from the 4 differentmesoderm (0 DM +/- FGF; 4 µM DM +/- FGF) were tested in this micromassassay. While all four mesoderm populations adhered to the dish (FIG. 2D)within 1 day of culture, different phenotypes were observed after 1week. Contracting (beating) cardiomyocytes, quantified by the expressionof cardiac troponin T (cTnT) by flow cytometry (FIG. 2E) were observedin micromasses derived from untreated mesoderm (0 DM, 0 FGF). Mesodermtreated with DM alone did not remain adherent to form chondrocytes, butinstead aggregated in long strands that were washed away with mediachanges. FGF-treated, as well as DM+FGF-treated cells survived the firstweek of micromass culture as an adherent layer of cells, and did notgenerate any cardiomyocytes. After 4 weeks of micromass culture, cellstreated in the monolayer phase with DM+FGF generated cartilage-liketissues that could be observed by eye (approximately 1 cm in diameter).Cells that were treated in monolayer phase with FGF alone did notmaintain a cartilage tissue phenotype, and detached from the culturedish (FIG. 2F). While both FGF-treated and DM+FGF-treated monolayercultures expressed similar levels of CD73/CD105/PDGFR-Beta, the paraxialgene expression at day 15, as well as the overall survival of thecartilage tissue, suggests that both BMP inhibition (here in the form ofDM treatment) and FGF stimulation is required to specify a paraxialmesoderm fate that has the potential to form cartilage-like tissuesin-vitro.

To determine if CD73, CD105 and PBeta are expressed on the populationswith chondrocytes potential in the hESC differentiation cultures,CD73+CD105+ and CD73-CD105- and CD73+PBeta+ and CD73-PBeta- fractionswere isolated from DM+FGF-treated monolayers on day 15 and assayed inthe micromass cultures (FIG. 3A). After 10 days in micromass theCD73+CD105+ cells and the CD73+PBeta+ cells adhered and survived. Thedouble-negative cells in both experiments failed to survive under theseconditions (FIG. 3B). After two weeks, cartilage tissues developed inthe cultures derived from the CD73+CD105+ and CD73+PBeta+ sorted cells(either maintained in TGFB3 or switched to BMP4-containing media). Incontrast, the double-negative cells in both cases failed to form anycartilage tissues (FIG. 3C). The differences in the potential togenerate cartilage tissue are shown in FIG. 3D. These data demonstratethat the CD73+CD105+PBeta+ cells have the potential to generatechondrocytes and cartilage-like tissues, while cells lacking theexpression of these markers do not.

Access to the appropriate paraxial mesoderm population derived at theend of stage 2, and the generation of chondrocyte progenitors at the endof stage 3, provided an opportunity to study the development of twosubtypes of chondrocytes, articular chondrocytes (ACs) and growth platechondrocytes (GPCs). After the paraxial mesoderm cells are stimulatedwith TGFb3 for about 10 days, these chondrocyte/cartilage cultures caneither be maintained in TGFb3 containing media or switched toBMP4-containing media for several months (stage 4). TGFb3 orBMP4-treated cultures form cartilage-like tissues over the course 12weeks that can be analyzed histologically using stains that indicate thepresence of a cartilage-specific extracellular matrix (toluidine blue)and by the expression of genes associated with either articularcartilage or growth plate cartilage. Morphologically, chondrocytes foundin TGFb3-treated cartilage tissues have a small fibroblastic-likephenotype, while BMP4-treated chondrocytes are round withcobblestone-like appearance (FIG. 4A). TGFb3-treated cartilage stainuniformly with toluidine blue contains small cells (chondrocytes)dispersed evenly throughout the tissue (13 week old tissues, FIG. 4B).In contrast, the BMP4-treated tissue contains enlarged hypertrophicchondrocytes. The remarkable increase in chondrocyte size inBMP4-treated cartilage tissues may be indicative of chondrocytehypertrophy, a normal process involved with GPC differentiation.Hypertrophic chondrocytes in the growth plate in-vivo are marked bycollagen 10 expression. The growth plate differentiation programultimately leads to cell death, leaving a calcified matrix on which newbone can be formed. Hypertrophy was also observed in BMP4-treatedcartilage tissues by flow cytometric analysis using forward and sidescatter plots of live cells (FIG. 4C). TGFb3-treated chondrocytes form atight population of smaller, less granular cells, while BMP4-treatedcells display a larger forward scatter (FSC), signifying larger cellsize, as well as a larger side scatter (SSC), signifying higher cellgranularity at all time points assessed (3 week and 5 week micromassesare shown).

Histologically, TGFb3-treated cartilage tissue appears to have many ofthe same characteristics of the future site of articular cartilage offetal femurs aged 19 weeks (upper panel, FIG. 4D), while hypertrophicchondrocytes found in BMP4-treated cartilages resemble the appearance ofthe growth plate chondrocytes found near the subchondral bone area ofthe fetal femur (lower panel). These phenotypes suggest that cartilagetissues with characteristics of the two unique subtypes of cartilagehave been generated in-vitro from human PSCs. Primary fetal chondrocytesisolated from the knee joint were also cultured in a micromass assay,identical to the protocol used for day 15 hPSC-derived paraxialmesoderm, and also generated cartilage tissue in-vitro. Histologically,TGFB3-treated and BMP4-treated fetal chondrocyte derived cartilagetissues also look very similar to cartilage tissues derived from hPSCs.FIG. 4E shows that replacing BMP-4 with GDF5 generates hypertrophicchondrocytes similar to those in FIG. 4A.

Similar differences in cell size and morphology were observed in12-week-old cartilage tissues generated from hiPSCs with TGFbeta3 andBMP4. Tissues stained metachromatically with Toluidine blue whichindicates the presence of proteoglycans (FIG. 4F). As expected, type IIcollagen protein was present in hPSC-derived tissues generated underboth conditions (FIG. 4G). Type X collagen was not detected in eithertissue at this time point. Lubricin protein was present in TGFbeta3- butnot in the BMP4-treated micromass tissue (FIG. 4H), and was foundpreferentially in the flattened cells that line the top of the tissuestructure. Taken together, these findings provide strong support for theinterpretation that sustained TGFbeta3 signaling promotes thedevelopment of articular chondrocytes that can generate articularcartilage-like tissue, whereas BMP4 signaling induces thedifferentiation of hypertrophic (enlarged) chondrocytes that formcartilage with growth plate characteristics.

The tissue generated under the two conditions was next analyzed for geneexpression patterns by qRT-PCR (FIG. 5 ) and for the presence ofspecific proteins associated with cartilage development byimmunohistochemistry and immunostaining (FIG. 4 ). Expression of SOX9and COL2A1, genes expressed by both articular and hypertrophicchondrocytes, was upregulated by 2 weeks of culture in both TGFbeta3-and BMP4-treated tissues (FIGS. 5A-B). The levels of expression weresimilar to those found in primary human fetal ACs, healthy adult ACs,and iliac crest (hypertrophic) chondrocytes. Expression of genesassociated with hypertrophic chondrocytes including RUNX2, SP7, alkalinephosphatase (ALP/ALPL), and COL10A1 was significantly higher in the 8-to 12-week old BMP4-treated tissue than in the tissue maintained inTGFb3 (FIGS. 5C-F). The reverse pattern was observed for genes known tobe expressed by superficial zone articular chondrocytes includinglubricin (PRG4) and cartilage intermediate layer protein 2 (CILP2)(FIGS. 5G-H), as well as for those expressed in joint interzone cells,the progenitor population of ACs, such as GDF5, WNT9A, and ERG (FIG.1-K).

Together, the histology and gene expression analyses of hPSC-derivedcartilages derived from TGFB3-treated cells and BMP4-treated cellssuggest that two unique chondrocyte populations and cartilage-liketissues have been generated in-vitro. The maturation of TGFB3-treatedcartilage tissues for an extended period of time (up to 12 weeks) allowsfor the expression of mature AC genes, such as lubricin and CILP2.Treatment of the TGFB3 cultures with BMP4 induces a hypertrophicresponse that is easily observed by histology and by the upregulation ofgenes associated with hypertrophic chondrocytes found in the growthplate, collagen 10 and Runx2. Thus, hPSC-derived cartilage tissuederived with TGFB3 treatment represents articular-like cartilage, whileBMP4-treated cartilage tissue represents growth plate-like hypertrophiccartilage.

In an effort to identify cell surface markers that can be exploited forthe enrichment of ACs either from hPSC differentiation cultures, or fromcartilage tissue isolated from patients for the purpose of autologouschondrocyte transplantation, we performed a flow cytometry basedantibody screen comprised of 350 antibodies. Several sources of primarychondrocytes from the knee joint were screened, including at least twosamples of human healthy adult articular cartilage that were used forallogeneic transplantations, at least 4 human fetal chondrocytes aged16-19 weeks of age, and 1 sample of human adult chondrocytes isolatedfrom the iliac crest in the hip area, which have growth platecharacteristics. From these screens, we identified CD73 as a marker ofarticular chondrocytes (FIG. 6 ). CD73 is expressed by virtually all(>96%) of healthy adult articular chondrocytes isolated from the knee,but it is expressed by only about 22% of iliac crest GPC-likechondrocytes (FIG. 6A). CD73 is expressed by approximately half of fetalchondrocytes (FIG. 6B), which may represent an impure population ofarticular chondrocytes as it is difficult to isolate just these cellsfrom the growth plate chondrocytes if the secondary ossification centrehas not yet been ossified, which happens during adolescence.

Primary (P0) and passaged (P2) fetal chondrocytes can also be culturedin micromass with TGFB3 or BMP4, similar to how hPSC-derived cartilagetissues are formed. TGFB3-treated fetal P0-derived or fetal P2-derivedcartilage tissues contain over 93% CD73 positive cells, while BMP4treatment reduces the percentage of CD73+ cells to 70% and 61%respectively (FIGS. 6C,D). CD73 expression is also expressed by over 98%of hPSC-derived cartilage tissues derived with TGFB3-treatment (FIG.6E). The percentage of CD73+ cells is reduced to only about 57% of cellsafter BMP4-treatment. Thus, CD73 marks primary healthy adult ACs, aproportion of healthy fetal chondrocytes, fetal chondrocytes or passagedfetal chondrocytes cultured as micromasses in TGFB3, and TGFB3-treatedarticular chondrocyte-like cells derived from human PSCs.

It is interesting that a mesenchymal cell surface marker such as CD73marks the hPSC-derived paraxial mesoderm early in the differentiation aswell as the end-stage articular-like chondrocytes derived from thatmesoderm. Paraxial mesoderm on day 12 (T12) and day 15 (T15) expressesboth CD73 and PDGFR-Beta, and after the three day ‘spotting’ phase (day18 total), all cells are CD73+PDGFR-Beta+ (FIG. 6F). Interestingly, bothof these cell surface receptors are downregulated after 10 days to 2weeks of micromass culture. After 4 to 5 weeks, CD73 becomes reexpressedin TGFB3-treated micromass cultures (FIG. 6G), suggesting that CD73 maybecome expressed when the chondrocyte progenitors are differentiatingtoward the articular chondrocyte fate.

To further characterize the potential of the two types of chondrocytes,cells from dissociated 8-12-week-old tissue were injected subcutaneouslyinto NSG immunodeficient mice. Both populations generatedproteoglycan-rich cartilage tissue that expressed type II collagen withno evidence of mineralization by 4 weeks following transplantation.Distinct differences were observed in the grafts after 12 weeks oftransplantation. Tissues derived from BMP4-treated chondrocytes retainedlittle proteoglycan (FIGS. 7A, C) and contained areas ofcalcification/mineralization and hypertrophy as revealed by positive vonKossa (FIG. 7B) and type X collagen staining (FIG. 7E), respectively.Interestingly, grafts from the TGFbeta3-treated chondrocytes maintaineda proteoglycan- (FIGS. 7A, C) and type II collagen-rich ECM (FIG. 7D)with no evidence of calcification/mineralization or hypertrophy (FIGS.7B, E). The findings from these transplantation studies demonstrate thatthe two chondrocyte populations are functionally distinct and provideadditional evidence that the TGFbeta3-treated cells represent articularchondrocytes as they generate and maintain stable cartilage for over 12weeks in vivo. Chondrocytes that developed in the presence of BMP4, bycontrast, display characteristics of those found in the growth plate, asthey gave rise to tissue that initiated endochondral ossification invivo.

COL2A1, PRG4 (lubricin) and CILP2 were also upregulated in micromasstissues treated with TGFbeta1 and TGFbeta2 for 12 weeks (FIG. 8 ),indicating that the generation of articular chondrocytes fromhPSC-derived paraxial mesoderm response was not ligand specific.

Access to an unlimited supply of hPSC-derived articular-like cartilageprovides an opportunity to establish platforms to analyze the effects ofpro-inflammatory cytokines such as interleukin-1α (IL1beta), known toplay a role in the early stages of osteoarthritis (OA). Treatment of10-week-old hPSC-derived ACs with IL1beta in the absence of TGFb3 fortwo weeks (FIG. 9A) resulted in the upregulation of expression ofcatabolic enzymes including matrix metallopeptidases 13 (MMP13) (FIG.9B) and MMP2 (FIG. 9C), and ADAMTS4 & S5 (FIGS. 9D,E). These enzymescleave proteins found in cartilage extracellular matrix (ECM), such ascollagens and aggrecans, which leads to the degradation of cartilagetissue. Significant upregulation of MMP13 and ADAMTS4 was observed onlyin the absence of TGFbeta3. ADAMTS5 was induced with or without TGFbeta3present. The expression of lubricin (PRG4) and CILP2 was alsodownregulated when IL1beta was added to tissues in the absence (FIGS.9H-I) or presence of TGFbeta3. The addition of IL1beta also led to areduction in COL2A1 and ACAN expression (FIGS. 9F-G), an increase invascular endothelial growth factor (VEGF) expression (FIG. 9J), and anoticeable loss of proteoglycans in the tissue (FIG. 9K). Together,these findings suggest that IL1beta signaling can initiate a transitionfrom an anabolic environment to a catabolic state in the hPSC-derivedACs, similar to that observed in native cartilage during early OApathogenesis.

Example 2

CD73+ cells represent articular non-hypertrophic chondrocytes, and thelack of CD73 positivity could identify growth plate-like hypertrophicchondrocytes.

Chondrocytes and cartilage-like tissues can be generated using a methoddescribed herein for the example the method described in Example 1.Articular chondrocyte cells can be isolated and/or separated fromprecursors or growth plate-like chondrocyte cells, using the CD73 cellmarker. As described herein, when AC-like cells are stimulated with BMP4they become hypertrophic and lose the expression of CD73 on their cellsurface. A method of monitoring expression of the CD73 cell surfacemarkers that can be used is the fluorescent-activated cell sorting(FACS) analysis.

Example 3 Use of hESC-Derived Chondrocytes or Cartilage for DrugToxicology Screenings

HESC-derived chondrocytes obtained using a method described in hereinfor example in Example 1 could be used for predictive drug toxicologyscreenings as well as drug discovery. For example, the cartilage tissueand/or hypertrophic chondrocyte cells typical of growth-plate-likecartilage tissue lineages as well as their precursors can be contactedwith a test substance and one or more biological endpoints measured suchas cell death. For example, cell death can be measured using for examplea vital cell dye exclusion assay, such as the Trypan Blue assay. Forinstance, AC-like chondrocytes which are exposed to a test substance(drug) can be monitored for cell toxicity after desired time-points bycounting the cells that are permeable to Trypan Blue dye. Other assaysinclude tetrazolim salt conversion assay. Examples of such assay includethe MTT assay as well as the WST-1 assay. The assay can be automated forhigh throughput screening.

Example 4 Use of hESC-Derived Chondrocytes or Cartilage in Testing CellProliferation as Induced by Test Substances

Another example of the use of hESC-derived chondrocytes is the testingof drugs that have an effect on cell differentiation or proliferation.Of particular interest would be the testing of drugs that can influencethe proliferation of primary articular chondrocytes into articularcartilage tissue, as monitored by the use of the CD73 marker whichindicates an AC-like fate. A variety of cell proliferation assays areavailable and can monitor response to a test substance of interest. Forinstance the ³H Thymidine incorporation assay monitors the proliferationof cells after treatment with a test substance or growth factor.Following such treatment, cells are incubated with ³H-thymidine for16-24 hours. An alternative assay is a 5-bromo-2′-deoxyuridine (BrdU)incorporation assay. Yet another alternative is the use of the use ofthe propidium iodine test. The fluorescence is directly proportional tothe DNA content in the samples. This method of monitoring cellproliferation can be particularly useful in the context of hESC-derivedchondrocytes as it can be used with cells that are grown on a monolayer.

Example 5 Use of Size and Granularity of Chondrocytes as a Way toDistinguish Cell Lineage

The disclosure describes methods for generating different lineages ofchondrocytes, more specifically the AC-like chondrocyte as well thegrowth-plate like chondrocytes. These lineages can for example bedistinguished based on size. For example, using the forward scatter(FSC-A) and side scatter (SSC-A) of hESC-derived chondrocytes, in theabsence of an antibody based staining observed during flow cytometricanalysis of live cells could be used. TGFB3 treated AC like cellpopulation displayed as a tight population of cells with generallyuniformly size and granularity, while BMP4-treated hypertrophicchondrocytes display a heterogeneous cell population that generally havelarger FSC-A and SSC-A attributes. Thus, FSC-A and SSC-A attributes oflive cells can be a useful readout in experiments where factors thatinduce or prevent chondrocyte hypertrophy are being tested.

Example 6 Monitoring of Cell Development and Cell Lineage Using ReporterGene Assays

A reporter gene assay can be used with the methods described herein toidentify factors and substances that maintain or alter the expression ofchondrocyte specific genes including mature cartilage genes such aslubricin or collagen 10. For example, a lubricin promoter- RFP (redfluorescent protein) targeted hESC line could be used for screening testsubstances that induce lubricin promoter activity and the expression ofRFP detectable by fluorescent microscopy. An increase in lubricinpromoter RFP+ expression, fluorescence, or an increase in the percentageof cells that express lubricin promoter RFP+ would indicate an increasein the percentage of cells that displayed non-hypertrophic articularlike chondrocyte characteristics. In contrast, a loss of lubricinpromoter RFP+ may indicate a loss of these cells and/or articularchondrocyte like characteristics.

Likewise, a collagen 10 reporter (such as collagen 10 promoter-GreenFluorescent Protein - GFP) would be useful in detecting an increase ordecrease in the level of collagen 10 expression in cartilage cells ortissues. An increase in collagen 10-GFP+ expression, fluorescence, or anincrease in the percentage of cells that express collagen 10-GFP wouldindicate an increase in the percentage of cells that displayedhypertrophic chondrocyte characteristics. In contrast, a loss ofcollagen 10-GFP may indicate a loss of hypertrophy.

The reporter lines can also be used in flow cytometry based screens.

Alternatively, a non-hypertrophic chondrocyte cell and/or hypertrophicchondrocyte cell can be transiently or stably transfected with areporter gene system where the reporter gene is functionally coupled toan articular chondrocyte specific promoter (i.e. articular chondrocytereporter system), optionally a lubricin promoter element and/or areporter gene functionally coupled to a hypertrophic chondrocytespecific promoter, optionally a collagen 10 promoter element (i.e.hypertrophic chondrocyte reporter system). The cells can be selected andthen contacted with a test substance. Test substances that inducearticular chondrocyte differentiation can be identified by measuring thearticular chondrocyte reporter system activity (e.g. relative to acontrol) and test substances that induce hypertrophic chondrocytedifferentiation can be identified by measuring hypertrophic chondrocytereporter system activity (e.g. relative to a control).

While the present application has been described with reference to whatare presently considered to be the preferred examples, it is to beunderstood that the application is not limited to the disclosedexamples. To the contrary, the application is intended to cover variousmodifications and equivalent arrangements included within the spirit andscope of the appended claims.

All publications, patents and patent applications are hereinincorporated by reference in their entirety to the same extent as ifeach individual publication, patent or patent application wasspecifically and individually indicated to be incorporated by referencein its entirety. Specifically, the sequences associated with eachaccession numbers provided herein including for example accessionnumbers and/or biomarker sequences ( e.g. protein and/or nucleic acid)provided in the Tables or elsewhere, are incorporated by reference inits entirely.

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1. A method for generating chondrocytes and/or cartilage, optionallyarticular like non-hypertrophic chondrocyte cells and/or cartilage liketissue and/or hypertrophic chondrocyte like cells and/or cartilage liketissue, the method comprising: a. culturing a primitive streak-likemesoderm population, optionally a CD56+ and PDGFRalpha+ primitivestreak-like mesoderm population, with a paraxial mesoderm specifyingcocktail comprising: i. a FGF agonist; ii. a BMP inhibitor; optionallyNoggin, LDN-193189, Dorsomorphin; and iii. optionally one or more of aTGFbeta inhibitor, optionally SB431542; and a Wnt inhibitor, optionallyDKK1, IWP2, or XAV939; to specify a paraxial mesoderm populationexpressing cell surface CD73, CD105 and/or PDGFR-beta; b. generating achondrocyte precursor population comprising: i. culturing the paraxialmesoderm population expressing CD73, CD105 and/or PDGFR-beta at a highcell density optionally in serum free or serum containing media; ii.culturing the high cell density CD73+, CD105+ and/or PDGFRbeta+ paraxialmesoderm population with a TGFbeta agonist in serum free media toproduce a high cell density Sox9+, collagen 2+ chondrocyte precursorpopulation; and c. either i. culturing the high cell density Sox9+,collagen 2+ chondrocyte precursor population with the TGFbeta agonistfor an extended period of time to produce an articular likenon-hypertrophic chondrocyte cells and/or cartilage like tissue; or ii.culturing the high cell density Sox9+ collagen2+ chondrocyte precursorpopulation with a BMP4 agonist for an extended period of time to producea hypertrophic chondrocyte like cells and/or cartilage like tissue. 2.The method of claim 1 for generating articular like non-hypertrophicchondrocyte cells and/or cartilage like tissue, wherein step c)comprises culturing the high cell density Sox9+, collagen 2+ chondrocyteprecursor population with a TGFbeta agonist for an extended period oftime to produce articular like non-hypertrophic chondrocyte cells and/orcartilage like tissue, optionally greater than 3 weeks.
 3. The method ofclaim 1 for generating hypertrophic chondrocyte like cells and/orcartilage like tissue wherein step c) comprises culturing the high celldensity Sox9+ collagen2+ chondrocyte precursor population with a BMP4agonist for an extended period of time to produce hypertrophicchondrocyte like cells and/or cartilage like tissue.
 4. The method ofany one of claims 1 to 3 wherein the paraxial mesoderm population iscomprised in embryoid bodies, monolayer culture and/or a combinationthereof.
 5. The method of claim 1 for generating articular likenon-hypertrophic chondrocyte cells and/or cartilage like tissue, themethod comprising: a. culturing a starting population of pluripotentstem cells with a primitive streak inducing cocktail to induce aprimitive streak-like mesoderm population expressing CD56 andPDGFR-alpha; b. culturing a primitive streak-like mesoderm populationwith a paraxial mesoderm specifying cocktail comprising: i. a FGFagonist; ii. a BMP inhibitor; optionally Noggin, LDN-193189,Dorsomorphin; and iii. one or more of a TGFbeta inhibitor, optionallySB431524; and a Wnt inhibitor, optionally DKK1, IWP2, or XAV939; tospecify a paraxial mesoderm population expressing cell surface CD73,CD105 and PDGFR-beta; c. generating a chondrocyte precursor populationcomprising: i. culturing the paraxial mesoderm population expressingCD73, CD105 and/or PDGFR-beta at a high cell density optionally in serumfree or serum containing media; ii. culturing the high cell densityCD73+, CD105+ and PDGFRbeta+ paraxial mesoderm population with a TGFbetaagonist in serum free media to produce a high cell density Sox9+,collagen 2+ chondrocyte precursor population; and d. culturing the highcell density Sox9+, collagen 2+ chondrocyte precursor population with aTGFbeta agonist for an extended period of time to produce an articularlike non-hypertrophic chondrocyte cells and/or cartilage like tissue. 6.The method of claim 1 for generating hypertrophic chondrocyte like cellsand/or cartilage like tissue, the method comprising: a. culturing astarting population of pluripotent stem cells with a primitive streakinducing cocktail to induce a primitive streak-like mesoderm populationexpressing CD56 and PDGFR-alpha; b. culturing a primitive streak-likemesoderm population with a paraxial mesoderm specifying cocktailcomprising: i. a FGF agonist; ii. a BMP inhibitor; optionally Noggin,LDN-193189, Dorsomorphin; and iii. optionally one or more of a TGFbetainhibitor, optionally SB431524; and a Wnt inhibitor, optionally DKK1,IWP2, or XAV939; to specify a paraxial mesoderm population expressingcell surface CD73, CD105 and PDGFR-beta; c. generating a chondrocyteprecursor population comprising: i. culturing the paraxial mesodermpopulation expressing CD73, CD105 and/or PDGFR-beta at a high celldensity optionally in serum free or serum containing media; ii.culturing the high cell density CD73+, CD105+ and PDGFRbeta+ paraxialmesoderm population with a TGFbeta agonist in serum free media toproduce a high cell density Sox9+, collagen 2+ chondrocyte precursorpopulation; and d. culturing the high cell density Sox9+ collagen2+chondrocyte precursor population with a BMP4 agonist for an extendedperiod of time to produce a hypertrophic chondrocyte like cells and/orcartilage like tissue.
 7. The method of claim 1 for generatingchondrocytes, the method comprising: a. culturing a starting populationof pluripotent stem cells with a primitive streak inducing cocktail toinduce a primitive streak-like mesoderm population expressing CD56 andPDGFR-alpha; b. culturing a primitive streak-like mesoderm populationwith a paraxial mesoderm specifying cocktail comprising: i. a FGFagonist; ii. a BMP inhibitor; optionally Noggin, LDN-193189,Dorsomorphin; and iii. one or more of a TGFbeta inhibitor, optionallySB431524; and a Wnt inhibitor, optionally DKK1, IWP2, or XAV939; tospecify a paraxial mesoderm population expressing cell surface CD73,CD105 and PDGFR-beta; c. generating a chondrocyte precursor populationcomprising: i. culturing the paraxial mesoderm population expressingcell surface CD73, CD105 and/or PDGFR-beta at a high cell density,optionally in serum free or serum containing media; ii. culturing thehigh cell density CD73+, CD105+ and PDGFRbeta+ paraxial mesodermpopulation with a TGFbeta agonist in serum free media to produce a highcell density Sox9+, collagen 2+ chondrocyte precursor population; and d.either i. culturing the high cell density Sox9+, collagen 2+ chondrocyteprecursor population with a TGFbeta agonist for an extended period oftime to produce an articular like non-hypertrophic chondrocyte celland/or cartilage like tissue; or ii. culturing the high cell densitySox9+ collagen2+ chondrocyte precursor population with a BMP4 agonistfor an extended period of time to produce a hypertrophic chondrocytelike cell and/or cartilage like tissue.
 8. The method of any one ofclaims 5 to 7, wherein the starting population is a human embryonic stemcell population (hESC) or an induced pluripotent stem cell population(iPSC), optionally primary hESC and/or iPSC.
 9. The method of claim 8wherein the hESC population is selected from a HES2 H1, H9, or any humaniPS cell line.
 10. The method of any one of claims 5 to 9, wherein thestarting population is aggregated into embryoid bodies.
 11. The methodof any one of claims 5 to 10, wherein the starting population iscontacted with the primitive streak inducing cocktail for about 1 toabout 5 days.
 12. The method of any one of claims 5 to 11, wherein theprimitive streak inducing cocktail comprises an activin agonist,optionally activin A or nodal, a BMP4 agonist, optionally BMP4, BMP2,BMP6, BMP7 and/or, BMP10, and a FGF agonist, optionally bFGF, FGF2,FGF4, FGF9 and/or optionally FGF 19, 21, 3, 5, 6, 8a, 16-18, 20 and/or23.
 13. The method of any one of claims 5 to 12, wherein the primitivestreak inducing cocktail further comprises a wnt agonist, optionallyselected from Wnt3a and a GSK3b inhibitor such as such as CHIR-99021(Stemolecule™ CHIR99021 Stemgent), 6-Bromolndirubin-3′-Oxime (BIO)(Cayman Chemical (cat:13123)), or Stemolecule™ BIO from Stemgent(cat:04003).
 14. The method of any one of claims 1 to 13, wherein theparaxial mesoderm is specified in a monolayer culture.
 15. The method ofany one of claims 1 to 14, wherein the BMP inhibitor is a type 1 BMPreceptor inhibitor, BMP ligands and/or soluble BMP receptors, optionallyselected from dorsomorphin (DM), noggin, Chordin, LDN-193189, solubleBMPR1a, soluble BMPR1b.
 16. The method of any one of claims 1 to 15,wherein the primitive streak-like mesoderm population is contacted withthe BMP inhibitor for about 1, 2, 3 or 4 days to inhibit cardiomyocytespecification.
 17. The method of any one of claims 1 to 16, wherein theFGF agonist for specifying the primitive streak-like mesoderm populationand/or the paraxial mesoderm population is selected from FGF2, bFGF,FGF4 and FGF9.
 18. The method of any one of claims 1 to 17, wherein theprimitive streak-like mesoderm population is contacted with the FGFagonist for at least 5 days, 6 days, 7 days, 8 days, 9 days, 10, days,11 days or more to increase the proportion of cells expressing CD73and/or CD105 by at least 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60% or65% compared to FGF agonist untreated cells.
 19. The method of any oneof claims 1 to 18, wherein the paraxial mesoderm population alsoexpresses transcription factors Meox1 and Nkx3.2 and is negative forNkx2.5.
 20. The method of any one of claims 1 to 19, wherein theparaxial mesoderm population is plated in a micromass culture, pelletculture or a filter culture or in any high cell density format.
 21. Themethod of claim 20, wherein the paraxial mesoderm population is platedat a cell density between 10 million cells/ml and 50 million cells/ml,optionally at least 10 million cells per 1 ml, 20 million cells/ml, 30million cells/ml, 40 million cells/ml or 50 million cells/ml in amicromass culture; or between 500,000 and 2 million, optionally about500,000, about 750,000, about 1 million, about 1.25 million, about 1.5million, about 1.75 million, about 2 million in a membrane filterculture.
 22. The method of any one of claims 1 to 21, wherein thepopulations are cultured in serum free basal media comprising insulin,transferrin and optionally selenium (ITS).
 23. The method of claim 22,wherein the basal media comprises DMEM with insulin, transferrin,selenium supplement, proline, and dexamethasone.
 24. The method of anyone of claims 1 to 23, wherein a paraxial mesoderm population iscultured at high cell density for about 0 to about 4 days, optionally 0,1, 2, 3, or 4 days before addition of TGFb3 agonist.
 25. The method ofany one of claims 1 to 24, wherein the CD73+, CD105+ and/or PDGFRbeta+paraxial mesoderm population is cultured with the TGFbeta3 agonist inserum free media for at least 3 days, or for about 3 days to about 14days, optionally at least a week, to produce a Sox9+, collagen 2+chondrocyte precursor population.
 26. The method of any one of claims 1,2, 4 to 24, wherein the extended period of time the Sox9+, collagen 2+chondrocyte precursor population is cultured with a TGFbeta agonist isat least 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9 weeks, 10 weeks,11 weeks, 12 weeks or more to produce an articular cartilage liketissue.
 27. The method of claim 26, wherein the chondrocyte precursorpopulation is cultured with the TGFb agonist until lubricin and/orcartilage intermediate layer protein 2 (CILP2) is expressed.
 28. Themethod of any one of claims 1 to 27, wherein the paraxial mesodermpopulation and/or the Sox9+, collagen 2+ chondrocyte precursorpopulation is cultured with a TGFb agonist selected from TGFb3 TGFb1,and/or TGFb2.
 29. The method of any one of claims 1, 3 to 27, whereinthe G hypertrophic chondrocyte like cells and/or cartilage like tissue,is cultured with the BMP4 agonist to produce a collagen 10+ and/orRunx2+ hypertrophic chondrocyte like cells and/or cartilage like tissue.30. The method of any one of claims 1, 3 to 27 and 29, wherein theextended period of time the high cell density Sox9+ collagen2+chondrocyte precursor population is cultured with the BMP4 agonist is atleast 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks, 9weeks, 10 weeks, 11 weeks, 12 weeks or more to generate a cartilagetissue that expresses collagen 2 or a hypertrophic chondrocytepopulation that expresses collagen
 10. 31. The method of any one ofclaims 1 to 30, wherein CD73+ CD105+ cells and/or CD73+ PDGFR-beta+cells are isolated, optionally by flow cytometry, from the paraxialmesoderm population expressing cell surface CD73, CD105 and/orPDGFR-beta prior to high cell density culture.
 32. The method of any oneof claims 1 to 31, wherein the chondrocyte precursors are cultured inTGFbeta agonist or BMP4 agonist for cartilage tissue formation.
 33. Themethod of claim 1 for generating chondrocyte like cells comprising: a.culturing chondrocyte precursor cells at a high cell density, optionallyin serum free or serum containing media; b. culturing the high celldensity chondrocyte precursor cells with a TGFbeta3 agonist in serumfree media; and c. either i. culturing the chondrocyte precursor cellwith a TGFbeta agonist for an extended period of time to produce anarticular cartilage like chondrocyte population; or ii. culturing thechondrocyte precursor cell with a BMP4 agonist for an extended period oftime to produce a hypertrophic chondrocyte population of cells and/orcartilage like tissue.
 34. The method of claim 33, wherein thechondrocyte precursor cells are primary fetal chondrocytes or passagedfetal chondrocytes.
 35. The method of claim 33, wherein the chondrocyteprecursor cells are primary cells obtained from a subject with acartilage or bone condition or disease.
 36. The method of any one ofclaims 1 to 35, wherein the steps are performed in vitro.
 37. The methodof any one of claims 1 to 36, wherein the generated cells and/or tissuesare administered to a subject.
 38. An isolated population of articularlike non-hypertrophic chondrocyte cells and/or cartilage like tissueand/or hypertrophic chondrocyte like cells and/or cartilage like tissue,generated according to the method of any one of claims 1 to
 37. 39. Acomposition comprising the population of articular like non-hypertrophicchondrocyte cells and/or cartilage like tissue and/or hypertrophicchondrocyte like cells and/or cartilage like tissue, and optionally adiluent or a carrier, optionally PEG, hydrogel, bone scaffolding, bonesubstitute scaffolding or matrigel.
 40. The composition of claim 39,wherein the composition is a cell slurry.
 41. The isolated cellpopulation of claim 38 or the composition of claims 39 or 40 furthercomprising endothelial cells or fibroblasts.
 42. A cartilage or bonetissue product comprising the cells or composition of any one of claims1 to 41, and a scaffold.
 43. The bone tissue product of claim 42,wherein the scaffold is a bone substitute.
 44. A method for amelioratingsymptoms and/or treating a subject in need thereof comprisingadministering the population of cells and/or tissues of any one ofclaims 38 to 41 and/or inserting the product of claim 42 or
 43. 45. Useof the population of cells and/or tissues or composition of any one ofclaims 38 to 41 and/or product of claim 42 or 43 for amelioratingsymptoms and/or treating a subject in need thereof.
 46. The method oruse of any one of claims 44 or 45, wherein the population of cells isinduced from autologous cells.
 47. The method or use of any one ofclaims 44 to 46, wherein the population of cells is enriched forarticular like non-hypertrophic chondrocyte cells and/or cartilage liketissue.
 48. The method or use of any one of claims 44 to 47 wherein thesubject has a joint condition such as osteoarthritis, osteochondritisdissecans, polychondritis, and other chondropathies, or joint injuriesaffecting the cartilage.
 49. The method or use of any one of claims 44to 45 wherein the population of cells is enriched for hypertrophicchondrocyte like cells and/or cartilage like tissue.
 50. The method oruse of claim 49, wherein the enriched hypertrophic chondrocyte likecells and/or cartilage like tissue, is adhered to a scaffold.
 51. Themethod or use of claims 44 to 46 and 50, wherein the subject has a bonecondition such as a bone fracture, bone break or is in need of a bonereplacement for example due to a malignancy, trauma or hasachondroplasia, osteogenesis imperfect, osteoporosis or otherosteopathies.
 52. A method of generating a paraxial mesoderm populationof cells comprising: a. culturing a starting population of pluripotentstem cells with a primitive streak inducing cocktail to induce aprimitive streak-like mesoderm population expressing CD56 andPDGFR-alpha; b. culturing a primitive streak-like mesoderm populationwith a paraxial mesoderm specifying cocktail comprising: i. a FGFagonist; ii. a BMP inhibitor; optionally Noggin, LDN-193189,Dorsomorphin; and iii. one or more of a TGFbeta inhibitor, optionallySB431524; and a Wnt inhibitor, optionally DKK1, IWP2, or XAV939; tospecify a paraxial mesoderm population expressing cell surface CD73,CD105 and/or PDGFR-beta.
 53. The method of claim 52, wherein the methodfurther comprises enriching CD73, CD105 and/or PDGFRbeta expressingcells.
 54. A method of isolating paraxial chondrogenic mesodermpopulation of cells comprising: a. contacting a population of cellscomprising paraxial chondrogenic mesoderm cells with a cocktailcomprising a CD73 specific binding agent, CD105 specific binding agent,and a PDGFRbeta specific binding agent; and b. enriching for CD73+,CD105+ and PDGFRbeta+ cells.
 55. The method of claim 53 or 54 whereinthe cells are enriched using flow cytometry.
 56. An isolated paraxialchondrogenic mesoderm population of cells prepared according to themethod of claim 52 to
 55. 57. A method of testing candidate chondrogenicmodulating substance, the method comprising: a. contacting a testsubstance with a chondrocyte precursor lineage cell population, the testsubstance contacted with the chondrocyte precursor lineage cellpopulation at any step in the method of any one of claims 1 to 37, 52 or53; b. assessing the effect of the test substance on chondrocyteproliferation, maintenance and/or differentiation compared to a controlpopulation generated in the absence of test substance; and c.identifying the test substance as a candidate chondrogenic modulatingsubstance if the test substance increases or decreases proliferation,and/or affects chondrocyte maintenance or differentiation compared tothe control.
 58. The method of claim 57, wherein the candidatechondrogenic modulating substance is a factor isolated from a subjectwith diseased cartilage or bone.
 59. The method of claim 58, wherein thefactor is isolated from a fat pad in a joint, optionally a knee joint,of a subject with arthritis and/or obese or from healthy subjects ascontrols.
 60. The method of claim 57, wherein the test substance isadded with the BMP4 agonist and the test substance is assessed for itsability to inhibit hypertrophy compared to controls treated in theabsence of the test substance.
 61. The method of claim 60, whereinhypertrophy is assessed using flow cytometry, optionally by assessingforward and side scatter.
 62. A method of isolating articularchondrocytes comprising: a. contacting a mixed population of cellscomprising chondrocytes with an antibody that binds CD73 underconditions that allow for the formation of an antibody:CD73 cellcomplex; and b. isolating the antibody:CD73 cell complex.
 63. The methodof claim 62, wherein the mixed population of cells comprises nonchondrocyte like cells, non-articular chondrocyte like cells andhypertrophic chondrocyte like cells.
 64. The method of claim 62 or 63,wherein the antibody is coupled to a tag such as a bead such as asepharose bead or magnetic bead.
 65. A method of assessing a candidatearticular chondrocyte proliferation inducer comprising: a. obtainingarticular like non-hypertrophic chondrocyte cells and/or cartilage liketissue generated according to the method of any one of claims 1, 2, 4 to37; b. culturing the articular like non-hypertrophic chondrocyte cellsand/or cartilage like tissue with a test substance; c. measuring thearticular like non-hypertrophic chondrocyte like cell proliferation; andd. detecting an increase in proliferation compared to articular likenon-hypertrophic chondrocyte cells and/or cartilage like tissue culturedin the absence of the test substance indicating that the test substanceis a candidate articular chondrocyte proliferation inducer.
 66. A methodof assessing a candidate hypertrophic chondrocyte proliferation inducercomprising: a. obtaining hypertrophic chondrocyte like cells and/orcartilage like tissue, generated according to the method of any one ofclaims 1, 3 to 37; b. culturing the hypertrophic chondrocyte like cellsand/or cartilage like tissue, with a test substance; c. measuringhypertrophic chondrocyte cell proliferation; and d. detecting anincrease in proliferation compared to hypertrophic chondrocyte likecells and/or cartilage like tissue, cultured in the absence of the testsubstance indicating that the test substance is a candidate hypertrophicchondrocyte proliferation inducer.
 67. The method of claims 65, whereina CD73 articular like non-hypertrophic chondrocyte cells and/orcartilage like tissue is isolated prior to culture with the testsubstance, optionally isolated by flow cytometry.
 68. The method of anyone of claims 65 to 67, wherein the articular like non-hypertrophicchondrocyte cell and/or hypertrophic chondrocyte like cell, cellcomprises a reporter gene functionally coupled to an articularchondrocyte specific promoter (i.e. articular chondrocyte reportersystem), optionally a lubricin promoter element and/or a reporter genefunctionally coupled to a hypertrophic chondrocyte specific promoter,optionally of collagen 10 promoter element (i.e. hypertrophicchondrocyte reporter system); and a compound that induces articularchondrocyte differentiation are identified by measuring the articularchondrocyte reporter system activity and a compound that induceshypertrophic chondrocyte differentiation are identified by measuringhypertrophic chondrocyte reporter system activity.
 69. The method of anyone of claims 65 to 68 wherein an increase in proliferation is measuredusing one or more of the following methods: a 3H Thymidine incorporationassay; a 5-bromo-2′-deoxyuridine (BrdU) incorporation assay; a propidiumiodine assay.
 70. A method of assessing AC cell and/or GPC cellprotective activity and/or toxicity of a test compound, comprising: a.generating articular like non-hypertrophic chondrocyte cells and/orcartilage like tissue and/or GPC like cells and/or growth platecartilage according to the method of any one of claims 1 to 37; b.culturing the articular like non-hypertrophic chondrocyte cells and/orcartilage like tissue and/or GPC cells and/or cartilage like tissue withthe test substance; c. measuring cell/tissue toxicity or chondrocyteprotective activity of the test substance; and d. detecting an increasein cell toxicity compared to articular like non-hypertrophic chondrocytecells and/or GPC cells and/or tissue cultured in the absence of the testsubstance indicating that the test substance is toxic to articularchondrocyte and/or GPC cells or detecting an increase in protectiveactivity (e.g. a decrease in cell toxicity) compared to articular likenon-hypertrophic chondrocyte cells and/or GPC cells and/or tissuecultured in the absence of the test substance indicating the testsubstance is protective .
 71. The method of claim 70, wherein celltoxicity is measured using one of the following assays: a Trypan bluedye assay; a luciferase assay; a tetrazolim salt conversion assay suchas a MTT assay and a WST-1 assay.
 72. The method of any one of claims 65to 70 wherein the proliferation, cell toxicity and/or protectiveactivity is assessed using one or more of the following analyses orassays: histological analysis, biochemical assays such as those thatquantify the production of glycosaminoglycans and proteoglycans, geneexpression analyses, gain/loss of a fluorescent reporter such aslubricin or collagen 10 by microscopy or flow cytometry, gain or loss ofCD73 cell surface receptor expression, assays for cell death, flowcytometry for cell size which can indicate chondrocyte hypertrophy. 73.The method of any one of claims 65-72 wherein the AC like chondrocytesand/or cartilage like tissue or the hypertrophic like chondrocytesand/or cartilage like tissue is/are contacted with a disease mediatoroptionally prior to culture with the test substance.
 74. The method ofclaim 73 wherein the disease mediator is a cytokine, optionallyIL-1beta, or a joint fat pad component.